When are tympanostomy tubes indicated in the treatment of acute otitis media (AOM)?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Some patients with AOM require ventilation or drainage of the middle ear cleft for an extended period (eg, patients with mastoiditis), whereas others may have a history of repetitive attacks. These patients benefit with the placement of a tympanostomy tube at the time of myringotomy. In most instances, general anesthesia or sedation is necessary in older children because topical anesthesia is relatively ineffective in acutely inflamed tympanic membranes.

Numerous tube designs are now available, each with its own weaknesses and strengths with respect to retention, reactivity, and complications. Selection of any tympanostomy tube design is governed by the length of time for which ventilation is likely to be needed. Tubes may be designed to permit tube placement for 6-9 months, for 9-18 months, or for longer than 2 years. Selection is also governed by the quality of the tympanic membrane’s fibrous tissue and by patient need versus the increasing complication rates associated with prolonged ventilation.


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