Key Points
- Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Each year, 667,000 children younger than 15 years receive tympanostomy tubes. By the age of 3 years, nearly 1 in 15 children (6.8%) will have tubes inserted.
- Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy.
- Children <7 years are at increased risk of otitis media because of their immature immune systems and poor function of the eustachian tube.
- Attendance at day care more than doubles the risk.
Table 1. Abbreviations and Definitions of Common Terms
| Term | Definition |
|---|---|
| Myringotomy | A surgical procedure in which an incision is made in the tympanic membrane for the purpose of draining fluid or providing short-term ventilation |
| Tympanostomy tube insertion | Surgical placement of a tube through a myringotomy incision for purposes of temporary middle ear ventilation. Tympanostomy tubes generally last several months to several years, depending on tube design and placement location in the tympanic membrane. Synonyms include ventilation tubes, pressure equalization tubes, grommets (United Kingdom), and bilateral myringotomy and tubes |
| Otitis media with effusion (OME) | The presence of fluid in the middle ear without signs or symptoms of acute ear infection |
| Chronic OME | OME persisting for 3 months or longer from the date of onset (if known) or from the date of diagnosis (if onset unknown) |
| Hearing assessment | A means of gathering information about a child’s hearing status, which may include caregiver report, audiologic assessment by an audiologist, or hearing testing by a physician or allied health professional using screening or standard equipment, which may be automated or manual. Does not include the use of noisemakers or other nonstandardized methods |
| Acute otitis media (AOM) | The rapid onset of signs and symptoms of inflammation of the middle ear |
| Persistent AOM | Persistence of symptoms or signs of AOM during antimicrobial therapy (treatment failure) and/or relapse of AOM within 1 month of completing antibiotic therapy. When 2 episodes of otitis media occur within 1 month, it may be difficult to distinguish recurrence of AOM (ie, a new episode) from persistent otitis media (ie, relapse) |
| Recurrent AOM | Three or more well-documented and separate AOM episodes in the past 6 months or at least 4 well-documented and separate AOM episodes in the past 12 months with at least 1 in the past 6 months |
| Middle ear effusion (MEE) | Fluid in the middle ear from any cause but most often from OME and during, or after, an episode of AOM |
| Conductive hearing loss (CHL) | Hearing loss, from abnormal or impaired sound transmission to the inner ear, which is often associated with effusion in the middle ear |
| Sensorineural hearing loss (SNHL) | Hearing loss that results from abnormal transmission of sound from the sensory cells of the inner ear to the brain |
| Tympanostomy tube otorrhea (TTO) | Discharge from the middle ear through the tube, usually caused by AOM or external contamination of the middle ear from water entry (swimming, bathing, or hair washing) |
| Retraction pocket | A collapsed area of the tympanic membrane into the middle ear or attic with a sharp demarcation from the remainder of the tympanic membrane |
| Tympanogram | An objective measure of how easily the tympanic membrane vibrates and at what pressure it does so most easily (pressure-compliance function). If the middle ear is filled with fluid (eg, OME), vibration is impaired and the line will be flat. If the middle ear is filled with air but at a higher or lower pressure than the surrounding atmosphere, the peak on the graph will be shifted in position based on the pressure (to the left if negative, to the right if positive) |
Table 2. Risk Factors for Developmental Difficultiesa
- Permanent hearing loss independent of OME
- Suspected or confirmed speech and language delay or disorder
- Autism-spectrum disorder and other pervasive developmental disorders
- Syndromes (eg, Down) or craniofacial disorders that include cognitive, speech,
or language delays - Blindness or uncorrectable visual impairment
- Cleft palate, with or without associated syndrome
- Developmental delay
aSensory, physical, cognitive, or behavioral factors that place children who have OME at increased risk for developmental difficulties (delay or disorder).
Diagnosis
Hearing Test
- Clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion. (R-C)
Table 3. Validated Questions for Assessing Hearing Difficulty by Caregiver Reporta
| Question | Responses | Pass | Fail |
|---|---|---|---|
| How would you describe your child’s hearing? | Normal, slightly below normal, poor, very poor | Normal | Slightly below normal, poor, or very poor |
| Has he/she misheard words when not looking at you? | No, rarely, often, always | No or rarely | Often or always |
| Has he/she had difficulty hearing when with a group of people (ie, not one-to-one)? | No, rarely, often, always | No or rarely | Often or always |
| These questions are suitable for children ≥3 years of age and should be used as an adjunct to (not substitute for) age-appropriate audiometry, or when audiometry produces inconclusive results or is not obtainable because of access or availability problems. | |||
| aA hearing difficulty is present when there is a fail response for 2 or more questions. | |||
