6
Management
Table 3. Comparison of AOM With and Without a
Tympanostomy Tube
Issue AOM without a tube AOM with a tube
Ear pain Mild to severe None, unless skin irritated
or tube occluded
Drainage from the ear
canal (otorrhea)
No, unless eardrum
ruptures
Yes, unless tube obstructed
Duration of MEE aer
infection
Can last weeks or months Usually resolves promptly
Needs oral antibiotics Oen Rarely
Needs antibiotic ear drops No benefit First line treatment
Risk of eardrum rupture Yes No, unless tube obstructed
Risk of suppurative
complications
Rare, but reported, since
the infection occurs in a
closed space
Likely very rare since
infection can drain through
the tube
Impact of therapy on
bacterial resistance
Systemic antibiotics can
promote resistance
Topical antibiotics generally
do not cause resistance
Table 4. Comparison of Short-term vs. Long-term
Tympanostomy Tubes
Characteristic Short-term tube Long-term tube
Examples (not exhaustive) Shephard, Armstrong,
Paparella I, Sheehy, Reuter
bobbin, grommet
Goode T-tube, modified
Richard's T-tube, other
t-tubes, butterfly, Paparella
II, Triune
Duration of ventilation* 8 to 18 months, on
average; some stay in place
3 years or longer
15 months or longer,
usually 2 to 3 years; some
stay in place 5 years or
longer
Indications Routine choice for first ear
tube surgery for a child
Selective choice for first
ear tube surgery for a child
when a need for prolonged
ventilation is anticipated;
option for repeat tube
surgery
