Tympanostomy tube insertion for otitis media in children

SBU’s Conclusions

This SBU report reviews the scientific evidence for tympanostomy tube insertion in the tympanic membrane (eardrum) of children with recurrent acute otitis media (inflammation of the middle ear) or long-term episodes of secretory otitis media (with fluid accumulation in the middle ear). Although these condi- tions eventually heal, approximately 10 000 Swedish children a year have such severe problems due to episodes of pain, reduced quality of life or hearing loss that tympanostomy tube insertion  is considered to be warranted. Annual socioeconomic costs asso- ciated with the conditions total approximately sek 600 million.

The systematic literature review, along with a survey of clinical practice, generated the following conclusions.

• The scientific evidence for tympanostomy tube insertion in children with recurrent acute otitis media is insufficient. Given that more than 2 000 Swedish children a year receive the treatment for this indication, reliable studies are needed as soon as possible.
• Tympanostomy tube insertion for long-term secretory otitis media improves hearing (Evidence Grade 1) and quality of life (Evidence Grade 2) for at least 9 months. Treating children with this indication in such a manner is justified if they have objectively verified hearing loss and accompanying reduction in quality of life. Forms that have been tested for children  with diseases of the ear can be used to assess quality of life.
• Adenoidectomy improves hearing at 6-month follow-up as effectively as tympanostomy tube insertion in children with long-term secretory otitis media (Evidence Grade 3). Combining tympanostomy tube insertion with adenoidectomy  does not lead to further hearing improvement at 3-month  follow-up (Evidence Grade 2).
• Suctioning out fluid in the middle ear in combination with tympanostomy tube insertion does not extend functionality  or reduce obstruction of the tube. Routine removal of tubes that are not spontaneously discharged has not been shown  to reduce the risk of complications.
• Bathing and swimming do not increase the risk of tympanos-tomy tube otorrhoea (discharge) (Evidence Grade 3). Preventive measures such as earplugs or eardrops when bathing  or swimming have little or no effect (Evidence Grade 2).
• The scientific evidence is insufficient to determine whether tympanostomy tube insertion is cost-effective for recurrent acute otitis media or secretory otitis media.