Tympanostomy tubes for children with acute otitis media

A 30-month-old patient in our clinic has had 4 episodes of acute otitis media (AOM) in the past 6 months. Should I refer the child and family to an ear, nose, and throat surgeon to consider tympanostomy tube placement, or should we continue medical management with antibiotics?

Acute otitis media is common among children in Canada, particularly those younger than 3 years of age. Recurrent AOM (3 or more episodes of AOM in a 6-month period or 4 or more episodes of AOM in a 12-month period) is also common in this age group. Routine immunization of infants and children in Canada with pneumococcal conjugate vaccines (initially the 7-valent PCV7 and more recently the 13-valent PCV13) considerably reduced the overall incidence of AOM. Tympanostomy tube placement decreases the incidence of AOM compared with medical management. However, the procedure is no longer superior to medical management after a 2-year period. Both tympanostomy tube placement and medical management are valid options for children with recurrent AOM, and shared decision making with caregivers is recommended.