II. 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

III. Efficacy: Persistent Serous Otitis

  1. Hearing improves in short-term
  2. At 18 months, hearing same as with watchful waiting
  3. Rovers (2005) Arch Dis Child 90:480-5 [PubMed]

IV. Adverse Effects

  1. Long-term Tympanic Membrane abnormalities
    1. May result in longterm reduced hearing
    2. Stenstrom (2005) Arch Pediatr Adolesc Med 159(12): 1151-6 [PubMed]

V. Management: Otitis Media with patent Tympanostomy Tubes

  1. Only Topical Antibiotics are needed if Tympanostomy Tubes are patent
  2. For maximal penetration
    1. Clear visible debris from ear canal
    2. 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. Combinations with steroid result in faster resolution but are much more expensive
    3. Ofloxacin (Floxin Otic) 5 drops (10 drops if over age 12) twice daily for 7 days
    4. Ciprofloxacin ophthalmic (ciloxan drops) 4 drops twice daily for 7 days
    5. Ciprofloxacin-Dexamethasone (Ciprodex) 4 drops twice daily for 7 days
    6. Ciprofloxacin-flucinolone (Otovel) 1 vial twice daily for 7 days
  4. References
    1. Schmelzle (2008) Can Fam Physician 54(8): 1123–7 [PubMed]

VI. 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

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Ontology: Tympanostomy (C0087123)

Definition (NCI) Surgical incision into the eardrum.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D008876
ICD9 20.0
ICD10 309
SnomedCT 148932003, 23354000, 265049001, 172677000, 397862008, 397760009
English Tympanostomies, Middle ear paracentesis, myringotomy (treatment), myringotomy, Incision of Eardrum, Tympanostomy, tympanocentesis, tympanostomy, tympanotomy, myringotomies, Tympanic memb. operat., Grommet procedure ear, Myringotomy (procedure), Myringotomy, Tympanotomy, Myringostomy, Tympanostomy (procedure), Tympanotomy (procedure)
Italian Miringotomia, Timpanostomia, Drenaggio trans-timpanico
Japanese 鼓膜切開, コマクセッカイ
Czech Myringotomie
French Myringotomie, Tympanostomie, Tympanotomie, Myringostomie
Hungarian Myringotomia
Norwegian Tympanostomi
Spanish miringostomía, miringotomía, timpanostomía (procedimiento), timpanostomía, timpanotomía (procedimiento), timpanotomía, Miringotomía
Portuguese Miringotomia
Dutch myringotomie
German Myringotomie