Consultation With the Specialist: Tympanostomy Tubes: A Contemporary Guide to Judicious Use

Abstract

1. Jack L. Paradise, MD* 2. Charles D. Bluestone, MD† 1. *Professor of Pediatrics and Otolaryngology, University of Pittsburgh School of Medicine; Children’s Hospital of Pittsburgh 2. †Professor of Otolaryngology, University of Pittsburgh School of Medicine; Director, Department of Pediatric Otolaryngology and Eberly Professor of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh, Pittsburgh, Pa After completing this article, readers should be able to: 1. Discuss the advantages of myringotomy and the insertion of tympanostomy tubes for children who have persistent otitis media with effusion (OME) or those who have recurrent acute otitis media (AOM). 2. Explain why myringotomy with tympanostomy tube insertion (M&T) is preferable to antimicrobial prophylaxis to prevent recurrent AOM for children in child care who are at increased risk of colonization with multiple drug-resistant Streptococcus pneumoniae . 3. Describe the possible complications following M&T and their treatments. MT of these, approximately 280,000 were in children younger than 3 years of age. The frequency with which the operation is performed is affected by several circumstances. First, next to the common cold, otitis media (OM), encompassing both AOM and OME, is the most commonly diagnosed and probably the most prevalent illness in United States children. Second, OM often becomes chronic and often recurs. Third, OM usually is accompanied by a variable degree of conductive hearing loss. Fourth, there has been concern that prolonged OME may result in untoward otologic or audiologic sequelae, and that sustained OME-related hearing loss during the first few years after birth, even though limited to that period, might result in later impairments of children’s speech, language, or cognitive skills or their psychosocial adjustment. Fifth, conservative measures often fail to prevent chronicity of OME or recurrences of AOM. Finally, M&T reliably brings about prompt resolution of persistent OME and its attendant hearing loss and usually succeeds in completely or largely preventing AOM recurrences for periods ranging from months to years. A 20-month-old boy presents …