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Children receive ear tubes more frequently than clinical guidelines and experts recommend

Research Activities, February 2009, No. 378

Otitis media, or middle ear inflammation, is the most common childhood ailment. Treatments are straightforward: watchful waiting, antibiotics, and surgery (tympanostomy tube insertion) as a last resort. A new study shows that many children who undergo this surgery do not meet criteria for receiving ear tubes: they generally did not have recurrent ear infections with fluid in both ears for 3 or more months, and had no hearing loss.

Researchers at New York's Mount Sinai School of Medicine convened an expert panel to develop criteria on the appropriateness of tympanostomy tube insertions for the treatment of otitis media. The investigators reviewed the cases of 682 children who had ear tubes inserted surgically in five metropolitan New York hospitals in 2002 and compared the clinical characteristics of the patients to the panel recommendations. The expert panel criteria deemed just 7 percent (48 cases) of the surgeries as appropriate, and nearly 70 percent (475 cases) as inappropriate. When the 1994 national clinical guidelines were compared to the clinical characteristics of children, the authors found 7.5 percent of the tubes insertions met guideline criteria, and nearly 93 percent did not.

The authors state that this widespread deviation from guidelines suggests ear tube insertion is overused and performed too quickly, exposing children to risk and using resources that could be otherwise spent improving children's health. However, if ear tubes do indeed improve children's quality of life and assist in language development in the short term, the guidelines' current focus on the long-term implications may need a second look.

Current national guidelines only focus on otitis media with effusion. There are no available national guidelines on the surgical treatment of acute otitis media. The expert panel also developed new criteria for when ear tubes are appropriate for acute otitis media. Generally, use of tympanostomy for this indication was deemed appropriate after short term or long term antibiotic prophylaxis failed for patients with a high frequency of infection. However, the authors caution that prophylactic antibiotics are used less often now due to concerns about antibiotic resistance. This study was funded in part by the Agency for Healthcare Research and Quality (HS10302).

See "Overuse of typanostomy tubes in New York metropolitan area: Evidence from five hospital cohort," by Salomeh Keyhani, M.D., M.P.H., Lawrence C. Kleinman, M.D., M.P.H., Michael Rothschild, M.D., and others in the October 3, 2008, British Medical Journal 337, pp. a1607, available at

Current as of February 2009
Internet Citation: Children receive ear tubes more frequently than clinical guidelines and experts recommend: Research Activities, February 2009, No. 378. February 2009. Agency for Healthcare Research and Quality, Rockville, MD.