The American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media with Effusion Clinical Practice Guidelines, published in Pediatrics in 2004, advocate a more conservative approach to insertion of ventilation tubes (Pediatrics 2004;113:1412–1429). These guidelines recommend watchful waiting without surgical procedures, with 3- to 6- month reassessments of symptoms, hearing, and the development of tympanic membrane pathologic abnormalities for normal, asymptomatic children with hearing thresholds of less than 40 dB.
Additionally, in a study published in Archives of Pediatric and Adolescent Medicine in December 2005, Robert Stenstrom, MD, et al. concluded that placement of ventilation tubes may actually cause harm to children in the long-term. The study, entitled, “Hearing Thresholds and Tympanic Membrane Sequelae in Children Managed Medically or Surgically for Otitis Media With Effusion” (Arch Pediatr Adolesc Med 2005;159:1151–1156), showed that insertion of ventilation tubes was associated with a 4.5-fold increase in risk of myringosclerosis and a 9.9-fold risk of tympanic membrane abnormalities at 6- to 10-year follow-up. Hearing thresholds were significantly poorer (5–11 dB HL) in patients exposed to ventilation tubes when compared with those who were not.
In an editorial regarding this study in the same issue of Archives of Pediatric and Adolescent Medicine, Steven Berman, MD, Professor of Pediatrics at the University of Colorado Health Sciences Center, concurred with these findings (Arch Pediatr Adolesc Med 2005;159:1183–1185). Dr. Berman stated in his editorial that it is reasonable to conclude that the long-term effects of ventilating tubes are additive to age-related sensorineural hearing loss and noise-induced hearing loss, and that they can have an adverse effect later in life. For this reason, Dr. Berman said in a telephone interview that he believes 20-year and 30-year follow-up studies would be helpful in determining just how serious the risk of these potential sequelae may be.
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