2015 HSC Section 1 Book of Articles

Rosenfeld et al

Benefits of Tympanostomy Tubes

Tympanostomy tube insertion is associated with short-term

QOL improvements.

Otitis media can affect QOL for the

child and caregiver. In one study of children with chronic

OME or recurrent AOM, 88% of caregivers were worried or

concerned about their child’s ear infections or middle ear fluid

at least some of the time, with 42% spending most or all of

their time preoccupied with their child’s condition.

Physical

suffering was a problem for 85% of children, emotional dis-

tress for 76%, and activity limitations for 57%. Another inves-

tigation of children with otitis media noted that 31% of

caregivers had to cancel family activities, 29% reported lack

of sleep, and 12% missed work or school.

The efficacy of tympanostomy tubes in managing chronic

OME, recurrent AOM, or both has been studied in randomized

controlled trials (RCTs) and systematic reviews. For children

with chronic OME, tube insertion reduces the prevalence of

MEE by 32% in the first year and improves average hearing

levels (HLs) by 5 to 12 dB.

7,13

Although RCTs have, in gen-

eral, not found a significant impact of tympanostomy tube

insertion on speech, language, or cognitive outcomes,

7,13,18

the

trials typically included only healthy children without devel-

opmental delays at entry. A nonrandomized study, however,

did show improved caregiver perception of speech and lan-

guage after tympanostomy tube placement, especially for chil-

dren with developmental delays.

The efficacy of tympanostomy tubes for preventing recur-

rent AOM is unclear, with systematic reviews reporting insuf-

ficient evidence,

small short-term benefits,

22,23

or moderate

benefits of similar magnitude to antibiotic prophylaxis.

Part

of this debate relates to inclusion criteria for RCTs in the

reviews, some of which excluded children with chronic OME

between AOM episodes and others that did not. When limited

Table 3.

Topics and issues considered in tympanostomy tube guideline development.

Indications for Tube Placement

Perioperative Management

Care of Children with Tubes

Outcomes

Otitis media with effusion

Baseline hearing assessment

Early extrusion of tubes

Quality of life (child and caregiver)

Recurrent acute otitis media

Optimal conditions for general

anesthesia (impact of upper

respiratory infections)

Dry ear (water) precautions

School performance, attendance

Persistent acute otitis media

Assessment for surgery

Tube otorrhea

Long-term sequelae (perforation,

retraction pocket, hearing loss)

Hearing loss caused by middle

ear effusion

Assessment of anesthetic

complications including

laryngospasm, hypoxemia,

bronchospasm

Tube granuloma or granulation

tissue

Vestibular function

Unacceptable antibiotic burden

for treating acute otitis media

Need for intravenous access

during surgery

Obstructed tube lumen

Hearing levels and outcomes

during life of tube and after tube

extrusion

Situations in which tube insertion

would be recommended

Need to sterilize ear canal prior

to tube placement

Postoperative hearing assessment Physical suffering (pain, sleep

disturbance)

Situations in which tube insertion

would be an option

Tube duration: short-term,

intermediate, long-term

Frequency of follow-up for

indwelling tubes

Speech and language development

Situations in which tube insertion

would not be recommended

Tube composition

Setting for follow-up; which

clinician is responsible or best

suited

Listening in complex environments

Tube location in the tympanic

membrane

Frequency of hearing assessment

(postoperative and for

surveillance)

Prevalence of middle ear effusion

Need to irrigate middle ear with

saline

Need for additional tube surgery

Use of perioperative topical otic

preparations

Need for oral antibiotics

Adenoidectomy as an alternative

or adjunct to tubes

Incidence of acute otitis media

Pain management after surgery

Incidence of otorrhea

Alternatives to general anesthesia

Chronic suppurative otitis media

Recovery room issues: emergent

delirium, nausea/vomiting,

parental/caregiver anxiety

Retained tube

Learning curve for tube surgery

Medialized tube

This list was created by the guideline development group to refine content and prioritize action statements; not all items listed were ultimately included or

discussed in the guideline.

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