resident physician Dalhousie University Halifax, Nova Scotia, Canada
Introduction: Recurrent acute otitis media (AOM) may warrant tympanostomy tube placement. However, patients presenting without middle ear effusion (MEE) do not meet indications for surgical intervention as outlined by the AAO-HNS guidelines. The objective of this study was to determine the need for tympanostomy tube placement when initial evaluation did not demonstrate MEE at our centre.
Methods: In this prospective cohort study, children presenting with recurrent AOM and no MEE were identified from October 2017 to March 2020 at a single tertiary care pediatric hospital. As per clinical practice guidelines, no surgery was offered initially. Patients were offered a semi-urgent return appointment should they experience another suspected AOM episode. If AOM or MEE was observed at the return visit, the option of tympanostomy tube insertion was provided. Patients were followed for one-year following enrolment.
Results: One-hundred and twenty-four patients were included. The median age was 3.15 years old (IQR 4.10). Seventy-five (60%) patients did not require additional follow-up and thus did not require tympanostomy tubes. Forty-nine (40%) were seen for re-evaluation as they developed possible AOM related symptoms. Of these, 11 patients received tympanostomy tubes. Therefore, 91.1% of patients did not require tympanostomy tubes. Patients who received tympanostomy tubes were younger on initial assessment than those who did not (mean difference 2.63 years, 95% CI 2.14-3.23).
Conclusion: This study demonstrates the practical effect of adhering to the clinical practice guidelines for recurrent AOM and suggests that many children do not require tympanostomy tube placement within the first year after consultation if they did not initially present with MEE.