The surgery, which is the most common outpatient procedure in children, is typically performed to reduce or eliminate middle ear infections, persistent fluid and related hearing loss. The updated guidelines are based on evidence from six clinical practice guidelines, 18 systematic reviews and 27 randomized controlled trials.
Nine things to know about the updated guidelines:
1. The guidelines now strongly recommend that the surgeon examines the child’s ears within three months after the tube insertion, and that the surgeon educates the child’s family on the need for routine follow-ups.
2. They include a new flowchart to clarify decision making.
3. They were created with an emphasis on patient education and shared decision making, and include new tables of counseling opportunities and frequently asked questions.
4. The guidelines include a new option for the clinician to perform adenoidectomy as a supplement to tube insertion for children with adenoid-related symptoms, or in children four years or older to reduce future recurring middle ear infections or the need for repeat tube insertion.
5. The guidelines now recommend against placing long-term tubes as the initial surgery, unless there is an anticipated need for prolonged middle ear ventilation.
6. They also now recommend against routinely prescribing prophylactic antibiotic ear drops after the surgery.
7. The list of risk factors that place some children suffering from middle ear infection at higher risk for developmental difficulties was updated with additional cognitive and psychological conditions.
8. The new guidelines have updated the categories of normal to mild hearing loss in children, with normal hearing as zero to 15 decibels, slight hearing loss as 16 to 25 dB, and mild hearing loss as 26 to 40 dB.
9. The group involved in updating the guidelines include professionals in otolaryngology, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology and consumer advocacy.