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Tympanostomy Tubes

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Treatment OME of Short Duration Î Clinicians should NOT perform tympanostomy tube insertion in children with a single episode of OME of less than 3 months' duration. (R-C) Chronic Bilateral OME with Hearing Difficulty Î Clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) AND documented hearing difficulties. (R-B) Chronic OME with Symptoms Î 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 to OME that include, but are not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life. (O-C) Recurrent AOM without MEE Î 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. (R-A) Recurrent AOM with MEE Î Clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral MEE at the time of assessment for tube candidacy. (R-B) Surveillance of Chronic OME Î Clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who did 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. (R-C) At-Risk Children Î 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 (see Table 2). (R-C) Î Clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for 3 months or longer (chronic OME). (O-C)

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