Update to clinical practice guideline on tympanostomy tube surgery for children

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published the Clinical Practice Guideline: Tympanostomy Tubes in Children (Update) today in Otolaryngology–Head and Neck Surgery. Tympanostomy tubes, also called ear tubes, are effective in reducing or eliminating middle ear infections and eliminating persistent middle ear fluid and hearing loss that is related to middle ear fluid.

"As the most common ambulatory surgery performed on children in the United States, insertion of tympanostomy tubes must be informed by trustworthy recommendations based on the best and most current research available, which is exactly what the new, fully updated CPG from AAO-HNSF accomplishes," said Richard M. Rosenfeld, MD, MPH, MBA, Chair of the Guideline Update Group (GUG).

The purpose of this CPG update is to reassess and update recommendations in the prior guideline and to provide clinicians evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. Revisions and additions in this update compared to the original 2013 CPG, include extensive patient education materials, opportunities for shared decision-making, expanded action statement profiles that now include quality improvement and implementation considerations, a flowchart that ties together all action statements in a cohesive management plan, a plain language version specifically for consumers and patients, and a dedicated webpage with downloadable patient education materials.

"Perhaps what is most exciting about the updated CPG is how it is part of a comprehensive suite of supporting materials," said Dr. Rosenfeld. "The bottom line is that tympanostomy tubes—inserted in the right child, for the right reason, and managed the right way—can offer children and families extraordinary benefits, which are best achieved by following the superb multidisciplinary guidance in this new update."

The original guideline, published in 2013 and now with more than 500 citations, offered the first trustworthy recommendations on tympanostomy tube indications and subsequent research showed excellent adherence by clinicians to guideline recommendations for tube insertion and for watchful waiting to reduce unnecessary surgery. The AAO-HNSF guideline remains the only publication explicitly focused on tympanostomy tube indications and managing children who receive tubes.

The guideline is intended for any clinician involved in managing children aged six months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for middle ear inflammation. The target audience for this CPG update includes specialists, primary care clinicians, and allied health professionals, as represented by the multidisciplinary GUG, which comprised the disciplines of otolaryngology-head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy.