Case Challenge: Acute Otitis Media in Children--Best Management Strategies

Gordon H. Sun, MD, MS


March 28, 2018

When to Recommend Tympanostomy Tubes

The AAP guideline for AOM management[1] suggests that tympanostomy tubes are an option for recurrent AOM (three episodes of AOM within 6 months or four episodes within 12 months, with at least one episode in the preceding 6 months). However, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guideline for tympanostomy tubes in children[2] specifically recommends tympanostomy tube placement only for patients with recurrent AOM plus persistent MEE.

For patients with recurrent AOM but no MEE at the time of assessment for candidacy for tympanostomy tube placement, the AAO-HNSF recommends against tympanostomy. As evidence, the guideline cited a 1992 randomized trial by Casselbrant and colleagues,[3] in which children with recurrent AOM (without MEE) underwent tympanostomy tube placement and had no reduction in subsequent episodes of AOM. However, tympanostomy tubes may be considered for patients without MEE if multiple antibiotic allergies or intolerance are present; if there are significant risk factors for developmental difficulties such as permanent hearing loss independent of otitis media with effusion, cleft palate, or speech/language delay or deficits; and in a few other exceptional instances. Furthermore, tympanostomy tubes are indicated for patients with a complication from otitis media.


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