Preventing Unnecessary Tympanostomy Tube Placement in Children: An Update

Saturday, September 28, 2024

10:06 AM – 10:12 AM EDT

Location: MBCC, 225

Disclosure(s):

Sofia Piperno, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Zachary S. Burgess, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The American Academy of Otolaryngology released guidelines in 2013 and 2022 that include statement 6: clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (RAOM) who do not have middle ear effusion (MEE) in either ear at the time of assessment for tube placement. This study’s primary objective is to assess statement 6 and evaluate its effectiveness. A secondary objective was to assess RAOM risk factors such as gender, school status, smoke exposure, and season of clinic presentation to see how they were related to successful watchful waiting (WW) or WW failure (tympanostomy tube placement).

Methods: A retrospective chart review was performed on children with RAOM, but without MEE at the time of assessment. Charts from August 1, 2013 to December 31, 2023 were analyzed. The RAOM risk factors of children in WW and those who failed WW were compared with chi square test and relative risk.

Results: In total, 285 patients met the inclusion criteria. Of those, 183 children remained in WW and did not receive ear tubes (64.21%). The other 102 children failed WW and required ear tubes (35.79%). There was a difference in age between groups (2.62 ± 1.87 years vs 1.79 ± 1.19 years, p < 0.005). There was no significant difference between gender and WW status (RR = 0.82 [0.61, 1.1], p < 0.05). Due to a skewed sample of males (n = 170) versus females (n = 115), the p value shows significance but not the relative risk. There was no significant difference between WW status and season of clinic presentation (RR = 0.99 [0.77, 1.29], p = 0.962), school status (RR = 0.95 [0.72, 1.25], p = 0.598), and smoking exposure (RR = 01.21 [0.83, 1.77], p = 0.463).

Conclusions: Statement 6 in the 2013 and 2022 tympanostomy tube guidelines prevents unnecessary tympanostomy tube placement in children with RAOM without MEE at the time of presentation. There was a 64.21% success rate when following these guidelines, consistent with a 66% success rate when this was studied at the same institution 5 years prior. There was no significant difference in WW status and RAOM risk factors.

Presenting Author(s)

Sofia Piperno, BS

Medical Student
The University of Texas Medical Branch
Spring, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Sofia Piperno, BS

Medical Student
The University of Texas Medical Branch
Spring, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Presenting Author(s)

Zachary S. Burgess, MD, MPH

Resident Physician
University of Texas Medical Branch, Department of Otolaryngology-Head and Neck Surgery
Galveston, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Zachary S. Burgess, MD, MPH

Resident Physician
University of Texas Medical Branch, Department of Otolaryngology-Head and Neck Surgery
Galveston, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Harold S. Pine, MD

Professor
University of Texas Medical Branch
Galveston, TX, United States

Disclosure information not submitted.