Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

• Published in: Otolaryngology-head and neck surgery 2022-02, Vol.166 (1_suppl), p.S1-S55
• Main Authors: Rosenfeld, Richard M., Tunkel, David E., Schwartz, Seth R., Anne, Samantha, Bishop, Charles E., Chelius, Daniel C., Hackell, Jesse, Hunter, Lisa L., Keppel, Kristina L., Kim, Ana H., Kim, Tae W., Levine, Jack M., Maksimoski, Matthew T., Moore, Denee J., Preciado, Diego A., Raol, Nikhila P., Vaughan, William K., Walker, Elizabeth A., Monjur, Taskin M.
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; developmental delay disorders; grommets; Humans; Infant; middle ear effusion; Middle Ear Ventilation; otitis media; Otitis Media - surgery; otorrhea; Patient Selection; pediatric otolaryngology; tympanostomy tubes
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/01945998211065662

Objective Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. Purpose The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. Methods In developing this update, the methods outlined in the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action” were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Sta