13
Table 6. Evidence-Based Recommendations for
Tympanostomy Tube Insertion
a
Statement Action Strength
Recommendations for performing tympanostomy tube insertion:
Chronic bilateral
OME with hearing
difficulty
Clinicians should offer bilateral tympanostomy
tube insertion to children with bilateral
OME for ≥3 months (chronic OME) AND
documented hearing difficulties.
R
Chronic OME with
symptoms
Clinicians may perform tympanostomy tube
insertion in children with unilateral or bilateral
OME for ≥3 months (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 QOL.
O
Recurrent AOM with
middle ear effusion
(or OME)
Clinicians should offer bilateral tympanostomy
tube insertion to children with recurrent AOM
who have unilateral or bilateral middle ear
effusion (or OME) at the time of assessment for
tube candidacy.
R
Tympanostomy tubes
in at-risk children
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 (chronic
OME).
O
Recommendations for NOT performing tympanostomy tube insertion:
OME of short
duration
Clinicians should NOT perform
tympanostomy tube insertion in children
with a single episode of OME of <3 months
duration.
R
(against
tubes)
Recurrent AOM
without middle ear
effusion (or OME)
Clinicians should NOT perform
tympanostomy tube insertion in children with
recurrent AOM who do not have middle ear
effusion (or OME) in either ear at the time of
assessment for tube candidacy.
R
(against
tubes)
a
From AAO-HNSF clinical practice guideline on tympanostomy tubes – Rosenfeld RM et al.
Otolaryngol Head Neck Surg. 2013;149(1 Suppl):S1-35. (Refer to the guideline for details on the
evidence and rationale underlying each recommendation.)
