What are the indications for tympanostomy (surgical incision into the tympanic membrane) per episode guidelines?

From the Guidelines

Tympanostomy tube insertion is indicated for children with chronic bilateral otitis media with effusion (OME) lasting 3 months or longer and documented hearing difficulties, as well as for those with recurrent acute otitis media (AOM) and middle ear effusion (MEE) at the time of assessment for tube candidacy, as stated in the 2022 clinical practice guideline update 1. The guidelines provide specific recommendations for the insertion of tympanostomy tubes in children, including:

• Children with bilateral OME for 3 months or longer and documented hearing difficulties should be offered bilateral tympanostomy tube insertion 1.
• Children with recurrent AOM who have unilateral or bilateral MEE at the time of assessment for tube candidacy should be offered bilateral tympanostomy tube insertion 1.
• Children with chronic OME lasting 3 months or longer and symptoms likely attributable to OME, such as balance problems, poor school performance, or ear discomfort, may be considered for tympanostomy tube insertion 1. The decision to insert tympanostomy tubes should be based on a comprehensive evaluation of the child's condition, including hearing evaluation and assessment of symptoms, as well as consideration of the potential risks and benefits of the procedure 1. Key considerations in the management of OME and AOM include:
• Hearing evaluation is recommended for children with OME that persists for 3 months or longer, or prior to surgery when a child becomes a candidate for tympanostomy tube insertion 1.
• Clinicians should reevaluate children with chronic OME who do not receive tympanostomy tubes at 3- to 6-month intervals until the effusion is no longer present or significant hearing loss is detected 1.

From the Research

Indications for Tympanostomy

• Tympanostomy tubes, also known as ventilation or grommet tubes, can be offered for recurrent acute otitis media (rAOM) 2.
• The decision to insert tympanostomy tubes should be based on the frequency and severity of AOM episodes, as well as the child's overall health and quality of life 3.

Guidelines for Tympanostomy Tube Insertion

• The American Academy of Pediatrics (AAP) recommends tympanostomy tube insertion for children with rAOM, defined as three or more episodes in six months, or four or more in one year 2.
• The AAP also recommends considering tympanostomy tube insertion for children with persistent middle ear effusion (MEE) lasting three months or longer, or for children with recurrent AOM who have a history of ear infections and have not responded to medical management 4.

Benefits and Risks of Tympanostomy Tube Insertion

• Tympanostomy tube insertion can reduce the frequency and severity of AOM episodes, improve hearing and speech development, and enhance quality of life 2, 3.
• However, tympanostomy tube insertion also carries risks, including persistent tympanic membrane perforation, otorrhea, and the potential for antibiotic resistance 2, 5.

Medical Management of Recurrent Acute Otitis Media

• Medical management of rAOM typically involves episodic antimicrobial treatment, as well as prophylactic antibiotics to prevent future episodes 4, 5.
• However, the use of prophylactic antibiotics should be cautious due to the risk of antibiotic resistance 4, 6.

Prevention of Recurrent Acute Otitis Media

• Breastfeeding has been shown to have a protective effect against rAOM 4.
• Avoiding cigarette smoke exposure and reducing pacifier use may also help prevent rAOM 4.
• Pneumococcal conjugated vaccines may have a moderate reductive effect on overall otitis media, but the effect on rAOM is still unclear 4.