17
KAS1
KAS2
At-risk child?*
KAS8
NO
OME ≥3 months?
YES
KAS9
Watchful waiting
NO
Clinician may
perform tubes
(option)
NO
Hearing evaluation
YES
Symptomatic
unilateral or
bilateral OME?**
KAS4
NO
YES
Decision to
insert tubes?
Surveillance every
3–6 months
KAS5
NO
First time child
having tubes?
Hearing evaluation
if not already done
KAS2
YES
Age ≥4 years
or adenoid
symptoms?
KAS11
NO
Option of adjuvant
adenoidectomy
YES
NO
KAS10
YES
OME ≥3
months or type B
tympanogram?
YES
