When is surgery contraindicated for 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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Contraindications for incision of the tympanic membrane are relatively few in the presence of acute disease. In 25 years of practice, the author has twice managed to tap through “thick tympanic membranes” to find himself aspirating CSF from low-hanging and exposed dura (one associated with a porencephalic cyst). Neither resulted in a prolonged complication, but CSF may be obtained with considerably less excitement via lumbar puncture.

Patients with patulous eustachian tubes most frequently have persistent otorrhea after placement of tympanostomy tubes. Children with neuromuscular disease, unrepaired cleft palates, or Down syndrome are more prone to this outcome. Otorrhea may be the lesser evil when the child is septic or uncomfortable or when damage to the middle ear cleft is imminent. This contraindication is a relative one, and the parent must be informed of the risk and allowed to participate in the decision whether to proceed.

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