What are the criteria for a tympanostomy (myringotomy with tube insertion)?

From the Guidelines

Tympanostomy tube placement is recommended for children with recurrent acute otitis media or chronic otitis media with effusion lasting 3 months or longer with hearing loss, as well as for those with chronic otitis media with effusion for 3-4 months with symptoms like balance problems, poor school performance, behavioral issues, or ear discomfort. The criteria for tympanostomy tube insertion include:

• Recurrent acute otitis media (defined as 3 or more episodes in 6 months or 4 or more episodes in 12 months with at least one episode in the past 6 months) 1
• Chronic otitis media with effusion lasting 3 months or longer with hearing loss 1
• Chronic otitis media with effusion for 3-4 months with symptoms like balance problems, poor school performance, behavioral issues, or ear discomfort 1 The procedure involves creating a small incision in the tympanic membrane and inserting a small tube to ventilate the middle ear and allow fluid drainage. Most tubes remain in place for 6-18 months before spontaneously extruding. Patients should avoid getting water in the ears while tubes are in place, using earplugs or a swim cap when swimming. Tympanostomy is effective because it equalizes pressure between the middle ear and external environment, improves eustachian tube function, reduces recurrent infections, and prevents complications like hearing loss, speech delays, and potential developmental issues in children with persistent middle ear problems 1.

Some key considerations for clinicians include:

• Obtaining a hearing evaluation if otitis media with effusion persists for 3 months or longer or prior to surgery when a child becomes a candidate for tympanostomy tube insertion 1
• Reevaluating children with chronic otitis media with effusion who do not receive tympanostomy tubes at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected 1
• Determining if a child with recurrent acute otitis media or with otitis media with effusion of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors 1

From the Research

Criteria for Tympanostomy

The criteria for tympanostomy tube placement vary depending on the specific condition being treated. For recurrent acute otitis media, the following criteria are considered:

• At least three episodes of acute otitis media within 6 months, or at least four episodes within 12 months with at least one episode within the preceding 6 months 2
• Abnormal ear examination at the time of clinic evaluation 3

Indications for Tympanostomy Tube Placement

Tympanostomy tube placement is recommended for:

• Children with recurrent acute otitis media (RAOM) and an abnormal ear examination 3
• Children with otitis media with effusion (OME) who have significant hearing loss, defined symptoms, or both 4
• Children with mild hearing loss due to OME and chronic adenoiditis, who may benefit from adenoidectomy or tympanostomy tube insertion 5

Contraindications and Considerations

The decision to perform tympanostomy tube placement should take into account the potential risks and benefits, including:

• The risk of otorrhea or persistent perforation of the tympanic membrane 4
• The potential for adverse events, such as those related to anesthesia or surgical complications 2, 5
• The effectiveness of alternative treatments, such as medical management or watchful waiting 2, 6