Preventing unnecessary tympanostomy tube placement in children

Philip F. Lavere, Jason F. Ohlstein, Steven P. Smith, Wasyl Szeremeta, Harold Pine

Research output: Contribution to journalArticle

Abstract

Objective: In 2013 the American Academy of Otolaryngology published tympanostomy tube guidelines for children; Action Statement 6 recommends against tube placement without middle ear effusion (MEE) at time of assessment. To date, little research has directly evaluated this recommendation in reducing the need for ear tubes. We evaluated the effectiveness of this recommendation and potential risk factors that influence the success of watchful waiting. Methods: Retrospective chart review collecting demographics, daycare status, smoking exposure, and time of year of visit. Children aged 6 months to 12 years without MEE on presentation, but with 3 or more episodes of acute otitis media (AOM) in 6 months or 4 or more episodes in 12 months, were assigned to watchful waiting (WW) treatment. These patients were followed every 4 months or returned sooner with additional infections. Any continued AOM, or MEE on follow up leading to tube placement, defined WW failure. Results: 123 patients met criteria, with 81 still in WW to date (66% success rate). 42 children failed WW and received tympanostomy tubes (34% failure rate). There were no statistically significant associations between age, race, gender, smoking exposure, daycare, or month of presentation between children who failed WW compared to children receiving tubes. Conclusions: Tympanostomy tube guidelines mitigate unnecessary tube placement in a majority of children with recurrent AOM without MEE. To our knowledge, this is the first study supporting the 2013 recommendations, with a 66% success rate. Additionally, no significant associations between modifying risk factors in those who failed watchful waiting were identified.

Original languageEnglish (US)
Pages (from-to)40-43
Number of pages4
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume122
DOIs
StatePublished - Jul 1 2019

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Middle Ear Ventilation
Watchful Waiting
Otitis Media with Effusion
Otitis Media
Smoking
Guidelines
Otolaryngology
Ear
Demography
Infection

Keywords

  • Middle ear effusion
  • Otitis media
  • Pediatrics
  • Tympanostomy tubes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

Preventing unnecessary tympanostomy tube placement in children. / Lavere, Philip F.; Ohlstein, Jason F.; Smith, Steven P.; Szeremeta, Wasyl; Pine, Harold.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 122, 01.07.2019, p. 40-43.

Research output: Contribution to journalArticle

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abstract = "Objective: In 2013 the American Academy of Otolaryngology published tympanostomy tube guidelines for children; Action Statement 6 recommends against tube placement without middle ear effusion (MEE) at time of assessment. To date, little research has directly evaluated this recommendation in reducing the need for ear tubes. We evaluated the effectiveness of this recommendation and potential risk factors that influence the success of watchful waiting. Methods: Retrospective chart review collecting demographics, daycare status, smoking exposure, and time of year of visit. Children aged 6 months to 12 years without MEE on presentation, but with 3 or more episodes of acute otitis media (AOM) in 6 months or 4 or more episodes in 12 months, were assigned to watchful waiting (WW) treatment. These patients were followed every 4 months or returned sooner with additional infections. Any continued AOM, or MEE on follow up leading to tube placement, defined WW failure. Results: 123 patients met criteria, with 81 still in WW to date (66{\%} success rate). 42 children failed WW and received tympanostomy tubes (34{\%} failure rate). There were no statistically significant associations between age, race, gender, smoking exposure, daycare, or month of presentation between children who failed WW compared to children receiving tubes. Conclusions: Tympanostomy tube guidelines mitigate unnecessary tube placement in a majority of children with recurrent AOM without MEE. To our knowledge, this is the first study supporting the 2013 recommendations, with a 66{\%} success rate. Additionally, no significant associations between modifying risk factors in those who failed watchful waiting were identified.",
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