Management of otitis media with effusion in children. Société française d’ORL et de chirurgie cervico-faciale clinical practice guidelines

Blanc, F.; Denis, Arnaud; Calmels, M.; Deguine, Olivier; François, M.; Leboulanger, Nicolas; Lescanne, E.; Marianowski, R.; Nevoux, J.; Nicollas, R.; Tringali, S.; Tessier, Natacha; Franco-Vidal, V.; Bordure, Philippe; Mondain, M.

doi:10.1016/j.anorl.2018.04.008

Cited by 19 publications

(23 citation statements)

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“…Another literature review of 10 randomized studies found that the hearing threshold had improved after TT placement, with a gain [95%CI] of 12 dB (Fergie et al., 2004; Rayner et al., 1998; Hall-Stoodley et al., 2006; Van Hoecke et al., 2016; Potera, 1999) in the first three months and 4 dB (Blanc et al., 2018; Casselbrant and Mandel, 2003; Flynn et al., 2009; Maris et al., 2014; Maw et al., 1999) from 6 to 9 months. However, the review did not find any evidence of a long-term effect of TTs on comprehensive and expressive language development (Browning et al., 2010).…”

Section: Treatmentsmentioning

confidence: 99%

“…The North American (Rosenfeld et al., 2013), (Rosenfeld et al., 2016), (Rosenfeld et al., 2004) and French (Blanc et al., 2018) guidelines recommend a 3-monthwait-and-see period prior to TT placement.…”

Section: Treatmentsmentioning

confidence: 99%

“…The middle ear effusion is mucous or sero-mucous in nature but not purulent. The condition lasts for at least three months; this sets it apart from persistent effusion after acute media otitis, which disappears after two months in 90% of cases (Blanc et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

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Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Vanneste

Page

2019

Journal of Otology

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Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases) tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed.

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Section: Treatmentsmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

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Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Vanneste

Page

2019

Journal of Otology

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“…A pesar de ello en un estudio de Hellström no se encuentran evidencias de una mejoría en la calidad de vida ni en la audición más allá de 9 meses tras la colocación de tubos de equipresión [12]. Otros estudios muestran que la mejoría en los umbrales auditivos tras colocar tubos de ventilación en de alrededor de 12 dB HL en los primeros tres meses [13][14][15] y no más de 5 dB de 6 a 9 meses tras su colocación [16,17] no habiéndose descrito evidencia alguna de su beneficio en cuanto a la inteligibilidad del lenguaje hablado o de un mayor desarrollo verbal en los niños que les portan [18]. En cualquier caso, los tubos transtimpánicos constituyen una primera línea de tratamiento bajando su eficacia sea el parámetro que se estudie entre los 6 y 18 meses tras su colocación [9] siendo universalmente recomendados en niños con disfunción crónica de su trompa de Eustaquio.…”

Section: Discussionunclassified

Diseño, modelado 3D y optimización del comportamiento mecanoacústico de un nuevo tubo de ventilación transtimpánico

Valdezate

Bragado

Hidalgo-Otamendi

et al. 2020

ORL

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Conflicto de intereses: Los autores declaran no tener conflictos de intereses Imágenes: Los autores declaran haber obtenido las imágenes con el permiso de los pacientes Política de derechos y autoarchivo: se permite el autoarchivo de la versión post-print (SHERPA/RoMEO) Licencia CC BY-NC-ND. Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional Universidad de Salamanca. Su comercialización está sujeta al permiso del editor

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“…6-8 These recommendations have been adopted, in part, by other countries publishing guidelines on OME that secondarily discuss tympanostomy tubes. 9-13 As such, the AAO-HNSF guideline remains the only publication explicitly focused on tympanostomy tube indications and managing children who receive tubes.…”

Section: Update Rationale and Scopementioning

confidence: 99%

Executive Summary of Clinical Practice Guideline on Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

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Objective This executive summary of the guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The summary and guideline are 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 executive summary is to provide a succinct overview for clinicians of the key action statements (recommendations), summary tables, and patient decision aids from the update of the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline: Tympanostomy Tubes in Children (Update).” The new guideline updates recommendations in the prior guideline from 2013 and provides clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. This summary is not intended to substitute for the full guideline, and clinicians are encouraged to read the full guideline before implementing the recommended actions. Methods The guideline on which this summary is based was developed using 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,” which were followed explicitly. The guideline update group represented the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Statements Strong recommendations were made for the following key action statements: (14) Clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. (16) The surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude. Recommendations were made for the following key action statements: (1) Clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months’ duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown). (2) Clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion. (3) Clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties. (5) Clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected. (6) Clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion (MEE) in either ear at the time of assessment for tube candidacy. (7) Clinicians should offer bilateral tympanostomy tube insertion in children with recurrent AOM who have unilateral or bilateral MEE at the time of assessment for tube candidacy. (8) Clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors. (10) The clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube. (12) In the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications. (13) Clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement. (15) Clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. Options were offered from the following key action statements: (4) Clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life. (9) Clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer. (11) Clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.

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Management of otitis media with effusion in children. Société française d’ORL et de chirurgie cervico-faciale clinical practice guidelines

Cited by 19 publications

References 50 publications

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Diseño, modelado 3D y optimización del comportamiento mecanoacústico de un nuevo tubo de ventilación transtimpánico

Executive Summary of Clinical Practice Guideline on Tympanostomy Tubes in Children (Update)

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