Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and <scp>Meta‐Analysis</scp>

Goel, Alexander N.; Omorogbe, Aisosa; Hackett, Alyssa M.; Rothschild, Michael A.; Londino, Aldo V.

doi:10.1002/lary.29342

Cited by 5 publications

(6 citation statements)

References 38 publications

(42 reference statements)

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“…About 25% of children will need a second set of short‐term tympanostomy tubes, and about 8% require a third set 201 . Risk factors associated with repeat tube placement, as determined by systematic review of the literature, include craniofacial disease and shorter retention time (eg, early extrusion) of the first set of ear tubes 201 .…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

“…201 Risk factors associated with repeat tube placement, as determined by systematic review of the literature, include craniofacial disease and shorter retention time (eg, early extrusion) of the first set of ear tubes. 201 Additional risk factors for repeat tympanostomy tube surgery, identified by other studies, include having a parent who is a smoker, daycare attendance, breastfeeding for under 3 months, pacifier use, tympanic membrane atelectasis, male sex, asthma, gastrointestinal disease, prematurity, and age. [205][206][207] With numerous risk factors identified from observational studies of varying risk of bias, it is difficult to predict which child would benefit from a longer duration of middle ear ventilation.…”

Section: Action Statement Profilementioning

confidence: 99%

“…Commonly used long‐term tubes, which typically remain in place for 2 years or longer, include Goode T‐tube, Butterfly, Triune, and Paparella type II. A short‐term tube is recommended for initial surgery because only a minority of children require repeat tube surgery 201 with the expectation of improved eustachian tube function while the tympanostomy tube is in place. This section does not discuss subannular ventilation tube placement, which is another means of achieving long‐term middle ear ventilation (median 35 months) in carefully selected children 202 …”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

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Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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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 Statements The GUG made strong recommendations for the following KASs: (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. The GUG made recommendations for the following KASs: (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 who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media 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. The GUG offered the following KASs as options: (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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Section: Guideline Key Action Statementsmentioning

confidence: 99%

Section: Action Statement Profilementioning

confidence: 99%

Section: Guideline Key Action Statementsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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“…5,6 Adenoidectomy can greatly improve the remission rate of OME, and adenoidectomy along with tympanotomy tube insertion can simultaneously reduce the repeated grommet insertion rate in children with OME. 7,8 Currently, there have been only a few relevant studies and conclusions regarding whether severe hypoxia during sleep occurs in children with OME. Braun et al found that there was no difference in the apneahypopnea index (AHI), apnea index (AI), hypopnea index (HI), snoring index, or nocturnal lowest oxygen saturation (LSaO 2 ) between children with OME and the control group.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypoxia in non-rapid eye movement sleep in children with otitis media with effusion

et al. 2022

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Objective This study aimed to analyze the status of hypoxia in non-rapid eye movement (NREM) sleep in children with otitis media with effusion (OME). Methods A total of 232 children with OME and/or adenotonsillar hypertrophy were enrolled in this retrospective study between August 2020 and November 2021. Polysomnographic monitoring was carried out, and the differences in polysomnographic results between the experimental group (children with OME and adenotonsillar hypertrophy) and control group (children with adenotonsillar hypertrophy only) were compared. Results The lowest oxygen saturation level during sleep was significantly lower in the experimental group (n = 36) than in the control group (n = 196). However, the apnea-hypopnea index, respiratory disorder index, apnea index, obstructive apnea index, obstructive apnea-hypopnea index, and mixed apnea-hypopnea index were significantly higher in the experimental group than in the control group. More importantly, the apnea-hypopnea index, the oxygen desaturation index, oxygen desaturation events, the average heart rate during NREM sleep, and the NREM stage in total sleep time were also significantly higher in the experimental group than in the control group. Conclusions Hypoxia during NREM sleep may affect the severity of OME in children.

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