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Tympanostomy Tube
Aka: Tympanostomy Tube, Pressure Equalization Tube, Tympanostomy, Myringotomy, PE Tube, Antibiotic Drops Via Patent Tympanostomy Tube
- 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)
- Efficacy: Persistent Serous Otitis
- Hearing improves in short-term, but no longterm benefit
- At 12-24 months, hearing same as with watchful waiting
- Rovers (2005) Arch Dis Child 90:480-5 [PubMed]
- Steele (2017) Pediatrics 139(6): e20170125 [PubMed]
- 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]
- 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
- Schmelzle (2008) Can Fam Physician 54(8): 1123–7 [PubMed]
- 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
- 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]