4
Management
Table 2. Summary of Guideline Key Action Statements (KAS)
Statement Action Grade
1. OME of Short
Duration
Clinicians should not perform
tympanostomy tube insertion in children
with a single episode of OME of less than
3 months' duration, from the date of onset
(if known) or from the date of diagnosis (if
onset is unknown).
Recommendation
(against)
2. Hearing
Evaluation
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.
Recommendation
3. Chronic
Bilateral OME
with Hearing
Difficulty
Clinicians should offer bilateral
tympanostomy tube insertion to children
with bilateral OME for 3 months or longer
AND documented hearing difficulties.
Recommendation
4. Chronic OME
with Symptoms
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.
Option
5. Surveillance of
Chronic OME
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.
Recommendation
6. Recurrent AOM
without MEE
Clinicians should not perform
tympanostomy tube insertion in children
with recurrent AOM who do not have
MEE in either ear at the time of assessment
for tube candidacy.
Recommendation
(against)
7. Recurrent AOM
with MEE
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.
Recommendation
8. At-Risk Children 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 (refer to
Table 6).
Recommendation
