Need for Tympanostomy Tubes in Children With Recurrent Acute Otitis Media Without Middle Ear Effusion

Area of Science:

• Pediatric Otolaryngology
• Otolaryngology
• Pediatrics

Background:

• Recurrent acute otitis media (RAOM) is common in children.
• Clinical Practice Guidelines (CPGs) recommend surgical intervention (tympanostomy tubes) only when middle ear effusion (MEE) is present.
• Children presenting with RAOM but without MEE do not meet current indications for surgery.

Purpose of the Study:

• To determine the rate of tympanostomy tube placement in children with RAOM who initially present without MEE.
• To evaluate adherence to CPGs in managing RAOM in pediatric patients.

Main Methods:

• A case series study was conducted at a single academic pediatric otolaryngology clinic.
• Children aged 0-12 years with RAOM and no MEE were identified between October 2017 and December 2019.
• Patients were followed for one year, with tympanostomy tube insertion offered only if MEE developed.

Main Results:

• Of 124 children included, 75% (60%) did not require tympanostomy tubes.
• Only 11 out of 49 patients (40%) who returned for follow-up ultimately received tympanostomy tubes.
• Overall, 91% of patients presenting with RAOM but no MEE did not require tympanostomy tubes within the study period.

Conclusions:

• Adherence to CPGs for RAOM is practical and effective.
• A significant proportion of children with RAOM who do not initially present with MEE may avoid tympanostomy tube placement within the first year.
• This suggests a conservative management approach is appropriate for RAOM without MEE.