What is the treatment for recurrent ear infections using tubes in the ears?

Treatment of Recurrent Ear Infections Using Tympanostomy Tubes

Tympanostomy tubes should be offered to children with recurrent acute otitis media (AOM) who have middle ear effusion (MEE) at the time of assessment for tube candidacy, as this can eliminate or reduce future infection episodes. 1

Indications for Tympanostomy Tubes in Recurrent Ear Infections

• Tympanostomy tubes are recommended for children with recurrent AOM (defined as 3+ episodes in 6 months or 4+ episodes in 12 months with at least 1 in the past 6 months) WITH persistent middle ear fluid in one or both ears at the time of assessment 1, 2
• Tubes are NOT recommended for children with recurrent AOM without persistent MEE, as the natural history is generally favorable and usually improves on its own 1
• For children with chronic otitis media with effusion (OME) lasting 3 months or longer and causing hearing loss, tympanostomy tubes should be offered to eliminate the fluid 1, 2
• Tubes may be considered earlier in children with risk factors for developmental difficulties (e.g., Down syndrome, cleft palate, permanent hearing loss, speech/language delay, autism spectrum disorder) 1, 2

How Tympanostomy Tubes Work

• Tympanostomy tubes are small tubes (approximately 1/20th inch wide) placed in the eardrum to ventilate the middle ear 1, 2
• Tubes allow air to enter the middle ear directly, bypassing the poorly functioning eustachian tube in children 1, 2
• They eliminate negative pressure (vacuum) that can cause fluid buildup and infections 1, 2
• Tubes allow any fluid to drain from the middle ear space, preventing buildup that can cause hearing loss 1, 2

Benefits of Tympanostomy Tubes for Recurrent AOM

• Reduction in future ear infection episodes by about 2.5 episodes per child-year 1, 2
• Decreased pain if AOM occurs with tubes in place 1
• Ability to treat infections with topical antibiotic eardrops instead of systemic antibiotics 1, 3
• Improved hearing outcomes (although this benefit typically disappears after 2 years) 1
• Better quality of life, including improved sleep, daytime behavior, and social interactions 2

Types of Tympanostomy Tubes

• Short-term tubes: Last approximately 8-18 months before naturally extruding 1, 2
• Long-term tubes: Last 2+ years but have higher risk of complications 1, 2
• Short-term tubes are recommended for initial surgery unless there is a specific need for prolonged ventilation 1, 2

Management of Ear Infections with Tubes in Place

• When AOM occurs with tubes in place, drainage (otorrhea) is often visible from the ear canal 2, 3
• Infections with tubes can typically be treated with antibiotic eardrops rather than oral antibiotics 1, 3
• For acute otitis media with tympanostomy tubes in children 1-12 years old: Five drops (0.25 mL) of ofloxacin otic solution instilled into the affected ear twice daily for ten days 3
• The tragus should be pumped 4 times after instillation to facilitate penetration of drops into the middle ear 3

Follow-up Care

• Regular monitoring every 3-6 months is recommended for children with ear tubes 1, 2
• If tubes extrude and recurrent ear infections resume, reassessment for potential replacement may be needed 1
• For children ≥4 years old with persistent or recurrent problems, adenoidectomy may be considered along with tube placement to reduce future recurrence 1, 2

Important Clinical Considerations

• Most ear problems resolve by age 7-8 years as the eustachian tube matures and the immune system develops 1, 2
• Potential complications include persistent tympanic membrane perforation after tube extrusion (risk higher with long-term tubes) and tympanostomy tube otorrhea 2
• The benefits of tympanostomy tubes should be weighed against procedural and anesthetic risks 1
• For children who do not receive tubes but have persistent MEE, follow-up should occur every 3-6 months to monitor ears and hearing 1

By following these evidence-based guidelines for tympanostomy tube placement in children with recurrent ear infections, clinicians can significantly reduce the burden of disease and improve quality of life for affected children.