Ear Tube Surgery Guidelines. Finally!

“Ear tubes are the #1 reason children get surgery or anesthesia in the United States. The tympanostomy tube placement 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.”

—Richard M. Rosenfeld, MD, MPH, chair of the AAO-HNSF Clinical Practice Guideline panel

Ear tubes are a necessary evil in the case of serious ear problems, but it can be hard to determine exactly if they need to be put in, and for how long. These decision are usually subjective; different doctors may prescribe different instructions for the same infection.

Fortunately, a new set of guidelines was recently released. These guidlines allow doctors to

1)      Identify children most likely to benefit from tympanostomy tubes

2)      Provide the best care before and after surgery, and

3)      Improve counseling and education for parents

Key points from the guideline

1. Many children with a fluid build-up (otitis media with effusion, or OME) in the middle ear (behind the eardrum) get better on their own. This is particularly the case for infections that have been there for less than 3 months.

2. Children with persistent OME for three months or longer should get an age-appropriate hearing test.

3. Tympanostomy tubes should be offered to children with hearing difficulties AND OME in both ears for AT LEAST three months.

4. Pursuant to the previous point, the tubes may be offered to children that ALSO exhibit symptoms that are likely attributable to OME–including: balance (vestibular) problems, and reduced quality of life.

5. When comparing ear infections who do not have middle-ear effusion (fluid behind the eardrum) to those that do, it seems that 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.

6. Tympanostomy tubes may be offered to children who are at-risk for developmental difficulties when OME is present and unlikely to cure soon, like children with permanent hearing loss or Down syndrome, among others.

7. Topical antibiotic ear drops should be used instead of oral (systemic) antibiotics where possible, since drops are more effective and have fewer side effects.

8. Children with tubes can usually swim or bathe without earplugs, or other precautions.

What are ‘tubes’ and why are they important?

• Insertion of tympanostomy tubes placement is the most common outpatient surgery performed on children in the United States, with over 600,000 annual procedures for children under 15 years of age. By age 3, nearly 1 in 15 children have tubes.

• Tympanostomy tubes are placed in the eardrum to treat persistent middle ear fluid (effusion), frequent ear infections, or ear infections that persist despite antibiotic therapy.

• The tubes allow air to circulate in the middle ear, and usually fall out on their own after one or two years.

Why is this guideline important?

• It is the first – and currently the only – evidence-based guideline on ‘ear tubes’.

• Created by a well-rounded panel including 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.

What is the purpose of the guideline?

• To help identify the children most likely to benefit from otolaryngology.

• To optimize the care of children both prior to, and post, the procedure.

• To provide better information to families considering tubes for their child.

About the AAO-HNS

The American Academy of Otolaryngology—Head and Neck Surgery (www.entnet.org)is a medical association in the U.S, representing over 10,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck.

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Published in the journal  Otolaryngology–Head and Neck Surgery, this is the FIRST evidence-based guideline in the United States for tubes (“Ear Tubes”, incidentally, are the most common reason for outpatient surgery and/or anesthesia performed on children in the U.S.)

About the Guidelines
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.

Otolaryngology–Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF). The guideline was published as a supplement to the journal’s July edition.

 
Questions or opinions? Let us know!