II. Indications: Tympanostomy Tube for age 6 months to 12 years
- Bilateral otitits media with effusion for 3 months or more with documented Hearing Deficit (>25 decibels)
- Refractory Otitis Media
- Recurrent Otitis Media and persistent effusion at evaluation for Tympanostomy Tube placement
- Three or more episodes in 6 months or
- Four or more episodes in 1 year (with at least one episode in last 6 months)
III. Efficacy: Persistent Serous Otitis
IV. Adverse Effects
- Long-term Tympanic Membrane structural abnormalities
- Associated with focal atrophy, Tympanosclerosis, retraction pockets, chronic perforation or Otorrhea, Cholesteatoma
- May result in longterm reduced Hearing
- Stenstrom (2005) Arch Pediatr Adolesc Med 159(12): 1151-6 [PubMed]
V. Management: Otitis Media with patent Tympanostomy Tubes
- Only Topical Antibiotics are needed if Tympanostomy Tubes are patent
- For maximal penetration
- See Ear Canal Instillation
- Clear visible debris from ear canal
- Pull tragus back and down several times after instilling drops
- Topical, non-ototoxic Antibiotic options
- Do not use Cipro HC Otic (not sterile)
- Avoid all cortisporin products (including suspension)
- Combinations with steroid result in faster resolution but are much more expensive
- Ofloxacin 0.3% (Floxin Otic) 5 drops (10 drops if over age 12) twice daily for 7 days
- Ciprofloxacin ophthalmic (ciloxan drops) 4 drops twice daily for 7 days
- Ciprofloxacin 0.3% with Dexamethasone 0.1% (Ciprodex) 4 drops in ear twice daily for 7-10 days
- Ciprofloxacin 0.3% with Fluocinolone Acetonide 0.025% (Otovel) 0.25 ml vial in ear twice daily for 7 days
- References
VI. Management: Swimming
- Ear plugs, head bands, or swimming avoidance is typically not required for those with Tympanostomy Tubes
- However, use ear plugs in the following situations
- Head submerged in soapy bath water
- Swimming in non-chlorinated water (e.g. lakes, rivers)
- Diving deeper than 6 feet
VII. References
- (2017) Presc Lett 24(6): 31-2
- Harmes (2013) Am Fam Physician 88(7):435-40 [PubMed]
- Rosenfeld (2013) Otolaryngol Head Neck Surg 149(1 suppl): S1-35 [PubMed]