Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media

Hoberman, Alejandro; Preciado, Diego; Paradise, Jack L.; David, Helena Maria Scherlowski Leal; Haralam, MaryAnn; Block, Stan L.; Kearney, Diana H.; Bhatnagar, Sonika; Pujalt, Gysella B Muñiz; Shope, Timothy R.; Martin, Judith M.; Felten, D; Kurs‐Lasky, Marcia; Liu, Hui; Yahner, Kristin; Jeong, Jong‐Hyeon; Cohen, Norman L.; Czervionke, Brian; Nagg, Jennifer P.; Dohar, Joseph E.; Shaikh, Nader

doi:10.1056/nejmoa2027278

Cited by 39 publications

(26 citation statements)

References 21 publications

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“…Secretory otitis media is a common disease in clinical pediatrics among infants and toddlers, whereby delayed treatment causes hearing loss [ 1 ]. Secretory otitis media is mainly characterized by ear aches, tinnitus, ear discomfort, hearing loss, and middle ear effusion [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Tympanic Membrane Catheterization Plus Ofloxacin Ear Drops in the Treatment of Secretory Otitis Media in Infants and Toddlers

Zhao

Chen

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the efficacy and safety of endoscopic tympanic membrane catheterization and ofloxacin ear drops in the treatment of secretory otitis media in infants and toddlers. Methods. A total of 80 children suffering from secretory otitis media who underwent treatment in our hospital from July 2018 to April 2020 were divided into the control group (n = 40) and experimental group (n = 40) by randomization. The control group was treated with endoscopic tympanic membrane catheterization alone, while the experimental group was treated with ofloxacin ear drops based on the same treatment as the control group. The treatment effect, air conduction hearing level, clearance rate of pathogenic bacteria secreted by the ear canal, recurrence rate, and adverse reactions were compared between the two groups. Results. The treatment in the experimental group led to a significantly better outcome than that in the control group ( P < 0.05 ). After treatment, a substantially improved air conduction hearing level in the experimental group was observed ( P < 0.001 ). A chi-square test showed a significantly higher clearance rate of pathogenic bacteria secreted from the ear canal of the children in the experimental group compared to that of the control group ( P < 0.05 ). The treatment in the experimental group resulted in a lower recurrence rate and adverse reaction rate as compared to the control group ( P < 0.05 ). Conclusion. Concurrent endoscopic tympanic membrane catheterization and ofloxacin ear drops showed excellent efficacy in the treatment of secretory otitis media in infants and toddlers. The therapy offers promising solutions for the improvement of hearing level, increase of clearance rate of pathogenic bacteria secreted from the ear canal, and decrease of disease recurrence and adverse reactions during treatment.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Tympanic Membrane Catheterization Plus Ofloxacin Ear Drops in the Treatment of Secretory Otitis Media in Infants and Toddlers

Zhao

Chen

2022

Evidence-Based Complementary and Alternative Medicine

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“…A more recent US randomized controlled trial among 250 children 6 to 35 months of age with recurrent AOM found no significant difference in the rate of episodes of AOM during a 2-year period in the intention-to-treat analysis (mean of 1.5 episodes, risk ratio 0.97; 95% CI 0.84 to 1.12; P=.66). 16 The time to first occurrence of AOM was longer in the TT group than in the observation group (4.34 months vs 2.33 months; hazard ratio=0.68, 95% CI 0.52 to 0.90). Children in the TT group had higher mean (SD) days per year with tube otorrhea (7.96 [1.10] vs 2.83 [0.78] days) but had fewer mean (SD) days per year with other otitis-related symptoms (2.00 [0.29] vs 8.33 [0.59] days).…”

Section: Myringotomy With Tt Insertionmentioning

confidence: 85%

“…11 Since the introduction of PCV7 and PCV13 there have been 3 main studies comparing the efficacy of TT insertion versus observation with episodic antimicrobial therapy among children with recurrent AOM. [14][15][16] A retrospective matched cohort study among more than 13,000 children younger than 5 years of age with recurrent AOM reported that the TT group had a lower 1-year incidence of episodes of AOM (1.96 vs 2.18, respectively; P<.001) and fewer oral antibiotic prescriptions (1.52 vs 1.67; P<.001). 14 However, at the 2-year follow-up, the difference between the TT group and the medically managed group was no longer significant for episodes of AOM (1.69 vs 1.66; P=.384) or number of oral antibiotic prescriptions (0.91 vs 0.87; P=.09).…”

Section: Myringotomy With Tt Insertionmentioning

confidence: 99%

Tympanostomy tubes for children with acute otitis media

Griffiths¹,

Goldman²

2022

Can Fam Physician

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Question 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?Answer 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.

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“… 7 Although TTs may not decrease the number of AOM episodes compared to medical management over the ensuing 2 years after placement, they do appear to reduce symptom severity and the need for oral antibiotics while increasing the time to a first occurrence of AOM. 8 Another study found that TT did not decrease the rate of new AOM episodes but did decrease the percentage of time with AOM compared to placebo. 7 Research on the occurrence of adverse events that may occur after TT placement surgery has also been challenging to synthesize because highly variable definitions are often used and follow‐up outcomes and duration are different between different studies, though there is literature exploring some of the most commonly reported adverse events after TT placement.…”

Section: Introductionmentioning

confidence: 99%

“…Otorrhea is a common occurrence after TT placement. 8 Van Dongen et al found that two‐thirds of children with TT experienced at least one episode of otorrhea in the year following placement. 9 They also determined that otorrhea in children with TT could be predicted by age, a recent history of upper respiratory tract infections, and the presence of older siblings.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of acute otitis media in primary care are associated with tympanostomy tube outcomes

Zhong

Hamdy

Pitter

et al. 2022

Laryngoscope Investig Oto

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Objective To identify characteristics of acute otitis media (AOM) at primary care presentation associated with TT placement and outcomes. Methods A retrospective cohort study of pediatric patients (birth—12 years old) with AOM at an academic primary care pediatric practice and affiliated tertiary referral free‐standing Children's hospital from August 1, 2017 to December 31, 2019 was performed. The outcomes measured were TT placement, postoperative otorrhea, need for additional tube placement, and other complications (i.e., perforation and/or granulation). Results The 3189 patients were included, 484 of whom were referred to otolaryngology. Multivariate logistic regression analysis revealed that a greater number of AOM episodes diagnosed at primary care was associated with tube placement (OR = 1.21; 95% CI, 1.04–1.41, p = .02). Of the 336 patients who received tubes, older age at first AOM diagnosis was associated with postoperative otorrhea (OR = 1.02; 95% CI, 1.01–1.03; p = .001) and additional tube placement (OR = 1.03; 95% CI, 1.02–1.04; p < .001). Older age was also associated with other complications (OR = 1.02; 95% CI, 1.01–1.03; p = .001) by univariate analysis. Additionally, postoperative otorrhea was more common among patients who first received an AOM diagnosis at primary care in the spring (OR = 2.69; 95% CI, 1.37–5.29; p = .004), summer (OR = 2.88; 95% CI, 1.46–5.69; p = .002), and fall (OR = 2.18; 95% CI, 1.20–3.96; p = .01) seasons. Conclusions Clinical data from pediatric primary care visits found older age at first AOM diagnosis and having a first AOM diagnosis outside of winter to be associated with a more complicated eventual disease course. Level of evidence 3—cohort study.

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Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media

Cited by 39 publications

References 21 publications

Efficacy and Safety of Endoscopic Tympanic Membrane Catheterization Plus Ofloxacin Ear Drops in the Treatment of Secretory Otitis Media in Infants and Toddlers

Efficacy and Safety of Endoscopic Tympanic Membrane Catheterization Plus Ofloxacin Ear Drops in the Treatment of Secretory Otitis Media in Infants and Toddlers

Tympanostomy tubes for children with acute otitis media

Characteristics of acute otitis media in primary care are associated with tympanostomy tube outcomes

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