New clinical guideline: pediatric ear tubes
A multidisciplinary clinical practice guideline that helps physicians identify children most likely to benefit from tympanostomy tubes, provide the best care before and after surgery, and improve counseling and education for parents was published in a supplement to the July edition of the journal Otolaryngology — Head and Neck Surgery. It is the first evidence-based guideline in the United States for tubes, the most common reason for outpatient surgery performed on children in the United States.
"The tympanostomy tube guideline not only helps doctors and parents identify children likely to benefit most from surgery, but importantly identifies those for whom watchful waiting may be a better option," said Richard M. Rosenfeld, MD, MPH, chair of the guideline panel.
Research shows that 667,000 tympanostomy tube procedures are performed annually on children under the age of 15. By age 3, nearly 1 in 15 children have tubes.
Despite the frequency of tympanostomy tube surgery, until now there have been no evidence-based recommendations in the United States to assist doctors in identifying the best surgical candidates and their subsequent care. The guideline, covering children aged 6 months to 12 years, was created by a panel that included a pediatric and adult otolaryngologist, otologist/neurotologist, anesthesiologist, audiologist, family physician, behavioral pediatrician, pediatrician, speech/language pathologist, advanced nurse practitioner, physician assistant, resident physician, and consumer advocates. The guideline’s authors are Richard M. Rosenfeld, MD, MPH, Seth R. Schwartz, MD, MPH, Melissa A. Pynnonen, MD, MSc, David E. Tunkel, MD, Heather M. Hussey, MPH, Jeffrey S. Fichera, PA-C, Alison M. Grimes, AuD, Jesse M. Hackell, MD, FAAP, Melody F. Harrison, PhD, Helen Haskell, MA, David S. Haynes, MD, Tae W. Kim, MD, Denis C. Lafreniere, MD, Katie LeBlanc, MTS, MA, Wendy L. Mackey, APRN, James L. Netterville, MD, Mary E. Pipan, MD, Nikhila P. Raol, MD, and Kenneth G. Schellhase, MD, MPH.
The guideline can be found at http://www.entnet.org/guide_lines/Tubes.cfm.
Significant Points in Tympanostomy Tube Guideline
- Many children with otitis media with effusion, or OME in the middle ear get better on their own, especially when the fluid is present for less than three months.
- Children with persistent OME for three months or longer should get an age-appropriate hearing test.
- Tympanostomy tubes should be offered to children with hearing difficulties and OME in both ears for at least three months, because the fluid usually persists and inserting tubes will improve hearing and quality of life.
- Tympanostomy tubes may be offered to children with OME, lasting at least three months in one or both ears, and symptoms that are likely attributable to OME, including balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life.
- Tympanostomy tubes should not be performed in children with recurrent (frequent) ear infections (AOM) who do not have middle-ear effusion (fluid behind the eardrum). In contrast, tubes should be offered when middle-ear effusion is present because the tubes will prevent most future AOM episodes and will allow episodes that do occur to be treated more safely, with ear drops instead of oral antibiotics.
- Tympanostomy tubes may be offered to children who are at-risk for developmental difficulties when OME is present in one or both ears and is unlikely to resolve quickly. This includes children with permanent hearing loss, speech/language delays or disorders, autism-spectrum disorder, Down syndrome, craniofacial disorders, cleft palate, and/or developmental delay.
- Ear infections that occur in children with tympanostomy tubes should be treated with topical antibiotic ear drops only, not with oral (systemic) antibiotics, since drops are more effective and have fewer side effects.
- Children with tubes can usually swim or bathe without earplugs, headbands, or other precautions.
Source: The American Academy of Otolaryngology — Head and Neck Surgery.
