Tympanostomy Tubes In Children: Update 2013
Otolaryngology–Head and Neck Surgery has published the first evidence-based guideline to help physicians decide which children are most likely to benefit from tympanostomy tubes. Tympanostomy tubes are the most common outpatient surgery for U.S. children and are the most common reason children undergo general anesthesia in the United States. Of note, some 667,000 tympanosotomy tube procedures are performed annually in the United States. By age 3, one in 15 children has tympanostomy tubes.
The 2013 guidelines note multiple major issues and points including: Many children with otitis media with effusion (OME) get better on their own, especially if the fluid is present less than three months. Children with OME for more than three months should have "an age-appropriate hearing test." If OME and hearing difficulty are present for more than three months in both ears, hearing and quality of life will be improved via tympanostomy tubes. Symptoms attributable to OME include "balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life."
Of note, the new guidelines state that tubes should not be used "in children with recurrent (frequent) ear infections (AOM) who do not have middle-ear effusion (fluid behind the eardrum). Further, for children who are at risk "for developmental difficulties when OME is present in one or both ears and is unlikely to resolve quickly," such as "children with permanent hearing loss, speech/language delays or disorders, autism-spectrum disorder, Down syndrome, craniofacial disorders, cleft palate, and/or developmental delay, tympanostomy tubes may be offered. Additionally, when ear infections do occur in children with tubes, the authors recommend topical antibiotic ear drops, rather than systemic oral antibiotics, as topical antibiotic ear drops are more effective and present fewer side effects. The new guidelines report that children who have tubes can generally swim or bathe without earplugs or headbands.
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