What are the indications for ventilation (ventilation) tube insertion?

Indications for Ventilation Tube Insertion

Ventilation tubes are indicated for children with persistent otitis media with effusion (OME) for at least 3 months with documented hearing difficulties, and for recurrent acute otitis media (AOM) with persistent middle ear effusion (MEE) in one or both ears at the time of assessment. 1

Primary Indications

• Chronic Otitis Media with Effusion (OME)

  • Persistent OME for ≥3 months with documented hearing difficulties 1
  • OME with hearing loss after a 3-month period of watchful waiting in children not at particular risk for speech, language, or learning problems 1

• Recurrent Acute Otitis Media (AOM)

  • Recurrent AOM with persistent middle ear effusion in one or both ears at the time of assessment 1
  • Benefits most evident in the first 6 months after insertion 1, 2

• At-Risk Children with OME

  • Children with risk factors for developmental difficulties who have OME 1

Risk Factors That Lower the Threshold for Intervention

• Developmental Risk Factors 1:
  • Permanent hearing loss independent of OME
  • Suspected or confirmed speech and language delay or disorder
  • Autism spectrum disorder
  • Down syndrome or other syndromes with cognitive, speech, or language delays
  • Blindness or uncorrectable visual impairment
  • Cleft palate (with or without associated syndromes)
  • Developmental delay
  • Intellectual disability, learning disorder, or attention-deficit/hyperactivity disorder

Clinical Decision-Making Algorithm

1. For OME:

   • If duration <3 months: Do not insert tubes 1
   • If duration ≥3 months: Obtain hearing evaluation 1
   • If hearing difficulties are documented: Consider tube insertion 1
   • If child has developmental risk factors: Lower threshold for intervention 1

2. For Recurrent AOM:

   • If persistent MEE is present in one or both ears: Consider tube insertion 1
   • If no persistent MEE: Tubes are less likely to be beneficial 1

Type of Tube Selection

• Short-term tubes should be the routine choice for first ear tube surgery 1

  • Duration: 8-18 months on average 1
  • Lower incidence of complications (perforation rate ~2%) 1

• Long-term tubes should only be used when prolonged ventilation is anticipated 1

  • Consider for specific conditions: cleft palate, Trisomy 21, stenotic ear canals 1
  • Also consider for atrophic/atelectatic tympanic membrane or history of premature extrusion of multiple prior short-term tubes 1
  • Higher complication rates (perforation rate ~17%) 1, 3

Adjunctive Procedures

• Adenoidectomy may be performed as an adjunct to tube insertion in 1:
  • Children with symptoms directly related to adenoids (adenoid infection or nasal obstruction)
  • Children aged ≥4 years to potentially reduce future recurrence of otitis media or need for repeat tube insertion

Clinical Outcomes and Follow-up

• Ventilation tubes reduce the number of AOM recurrences by approximately 1.5 episodes in the first 6 months after insertion 2
• Tubes may reduce persistent OME by 70% at 6 months compared to no treatment 4
• Long-term follow-up (14 years) shows that 74.7% of ears treated with early VT insertion heal completely 5
• Retention period of at least 2 years may be beneficial for preventing OME recurrence 6

Potential Complications

• Tympanic membrane perforation (2% with short-term tubes, 17% with long-term tubes) 3
• Otorrhea (ear discharge) occurs in 26-75% of children with tubes 1
• Other sequelae: tympanosclerosis, focal atrophy, shallow retraction pockets 3

Important Caveats

• Benefits of tubes for recurrent AOM are mainly evident in the first 6 months after insertion 1, 2
• Tubes may not be helpful for recurrent AOM without persistent MEE 1
• The magnitude of effect for ventilation tubes in preventing recurrent AOM is modest 1
• Children who are healed after 5 years of follow-up generally do not need further monitoring 5