Clinical Practice Guideline on Tympanostomy Tube in Children Update (AAO-HNS)
Reviewed by Richard (Wei Chern) Gan

The American Academy of Otolaryngology–Head and Neck Surgery Foundation’s ‘Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)’ has been recently published - an update of the original 2013 guideline. This article forms an executive summary to accompany the full guideline. This guideline pertains to patients aged six months to 12 years old. Sixteen key actions statements are discussed (some are paraphrased here). Strong recommendations: (14) Should prescribe topical antibiotic ear drops only without oral antibiotics for children with uncomplicated acute tympanostomy tube otorrhoea; (16) Examine ears within three months of tympanostomy tube insertion (TTI) and educate families regarding need for routine, periodic follow-up to examine ears until tube extrudes. Recommendations: (2) Hearing evaluation should be obtained for otitis media with effusion (OME) >3 months or prior to TTI; (3) Offer TTI if OME >3 months and documented hearing difficulties; (5) Children with chronic OME who do not receive tympanostomy tubes should be re-evaluated at three-to-six-month intervals until effusion resolves, significant hearing loss is detected, or structural abnormalities of tympanic membrane or middle ear are suspected; (7) Offer TTI for recurrent acute otitis media (AOM) with unilateral or bilateral middle ear effusion; (8) Determine if child is at increased risk of speech, language and learning problems due to otitis media because of baseline sensory, physical, cognitive or behavioural factors; (12) Perioperative education should be given to caregivers regarding expected tube function duration, follow-up schedule and detection of complications. Recommendations against: (1) Clinicians should not insert tympanostomy tubes in children with single OME episode <3 months duration from date of onset or diagnosis (if date of onset unknown); (6) Should not insert tympanostomy tubes for recurrent AOM without middle ear effusion in either ear; (10) Should not place long-term tubes as initial surgery unless there is specific reason based on anticipated need for prolonged middle ear ventilation; (13) Should not routinely prescribe antibiotic ear drops after TTI; (15) Should not encourage routine prophylactic water precautions (ear plugs, head bands, avoidance of swimming/water sports) for children with tympanostomy tubes. Option statements: (4) Tube insertion for unilateral or bilateral OME >3 months and symptoms attributable (all or in part) to OME including, but not limited to, balance, school performance, behavioural and quality of life problems and ear discomfort; (9) May perform TTI in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by type B tympanogram or documented effusion >3 months; (11) Adenoidectomy may be performed in children with symptoms directly related (adenoid infection, nasal obstruction) or age >4 years to reduce recurrent otitis media or repeated TTI. At present, there is insufficient evidence to provide recommendations regarding in-office (without general anaesthetic) tympanostomy tube insertion in children. At risk patients (8) should be identified as may benefit from prompt evaluation, early intervention and more active surveillance.

Executive Summary of Clinical Practice Guideline on Tympanostomy Tubes in Children (Update).
Rosenfeld RM, Tunkel DE, Schwartz SR, et al.
OTOLARYNGOL HEAD NECK SURG
2022;166(2):189-206.