Which children would benefit most from tympanostomy tubes (grommets)? A personal evidence-based review

Otitis media with effusion (OME) is a common condition in young children. OME causes some hearing loss, and can cause permanent changes in the tympanic membrane as well as other symptoms. In most cases OME is of short duration. As long-lasting bilateral OME for decades has been associated with delayed cognitive and language development, parents and ENT specialists have a positive attitude towards treatment with tympanostomy tubes (TT).

This personal evidence-based review is build on own observations and research combined with newer studies and guidelines.

The review argues for a relatively restrictive treatment policy concerning the use of TT in children with OME without signs or symptoms of impaired social or linguistic function.

Six months with bilateral OME and significant hearing loss should be present before treatment with TT in otherwise healthy children. At the moment we have no evidence for the subgroups of children excluded from the RCTs, i.e. children with speech/language delays, behaviour and learning problems, or syndromes. Clinicians will need to make their own decisions regarding treatment of such children. The situation just now is that some children are over-treated and some are under-treated. There is an urgent need for prospective cohort studies and randomised studies on children with long-lasting OME in an attempt to characterise the children who would benefit most from TT.