Tympanostomy Tube

1. Indications: Tympanostomy Tube for age 6 months to 12 years
   1. Bilateral otitits media with effusion for 3 months or more with documented Hearing Deficit (>25 decibels)
   2. Refractory Otitis Media
   3. Recurrent Otitis Media and persistent effusion at evaluation for Tympanostomy Tube placement
      1. Three or more episodes in 6 months or
      2. Four or more episodes in 1 year (with at least one episode in last 6 months)
2. Efficacy: Persistent Serous Otitis
   1. Hearing improves in short-term, but no longterm benefit
   2. At 12-24 months, hearing same as with watchful waiting
      1. Rovers (2005) Arch Dis Child 90:480-5 [PubMed]
      2. Steele (2017) Pediatrics 139(6): e20170125 [PubMed]
3. Adverse Effects
   1. Long-term Tympanic Membrane structural abnormalities
      1. Associated with focal atrophy, Tympanosclerosis, retraction pockets, chronic perforation or Otorrhea, Cholesteatoma
      2. May result in longterm reduced hearing
      3. Stenstrom (2005) Arch Pediatr Adolesc Med 159(12): 1151-6 [PubMed]
4. Management: Otitis Media with patent Tympanostomy Tubes
   1. Only Topical Antibiotics are needed if Tympanostomy Tubes are patent
   2. For maximal penetration
      1. See Ear Canal Instillation
      2. Clear visible debris from ear canal
      3. Pull tragus back and down several times after instilling drops
   3. Topical, non-ototoxic antibiotic options
      1. Do not use Cipro HC Otic (not sterile)
      2. Avoid all cortisporin products (including suspension)
      3. Combinations with steroid result in faster resolution but are much more expensive
      4. Ofloxacin 0.3% (Floxin Otic) 5 drops (10 drops if over age 12) twice daily for 7 days
      5. Ciprofloxacin ophthalmic (ciloxan drops) 4 drops twice daily for 7 days
      6. Ciprofloxacin 0.3% with Dexamethasone 0.1% (Ciprodex) 4 drops in ear twice daily for 7-10 days
      7. Ciprofloxacin 0.3% with Fluocinolone Acetonide 0.025% (Otovel) 0.25 ml vial in ear twice daily for 7 days
   4. References
      1. Schmelzle (2008) Can Fam Physician 54(8): 1123–7 [PubMed]
5. Management: Swimming
   1. Ear plugs, head bands, or swimming avoidance is typically not required for those with Tympanostomy Tubes
   2. However, use ear plugs in the following situations
      1. Head submerged in soapy bath water
      2. Swimming in non-chlorinated water (e.g. lakes, rivers)
      3. Diving deeper than 6 feet
6. References
   1. (2017) Presc Lett 24(6): 31-2
   2. Harmes (2013) Am Fam Physician 88(7):435-40 [PubMed]
   3. Rosenfeld (2013) Otolaryngol Head Neck Surg 149(1 suppl): S1-35 [PubMed]