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Clinical
Indications for Myringotomy (Ear) Tubes
American Academy of Otolaryngology-Head and Neck Surgery,
Bulletin June 2000 Vol. 19 No. 6, and the position statement from
the
American Academy of Pediatrics Subcommittee on Otitis Media with Effusion;
American Academy of Family Physicians; American Academy of Otolaryngology--Head
and Neck Surgery
View Abstract
Click on colored text
for word definitions !!
1. Severe
acute otitis media
(middle ear
infection)
2. Hearing loss greater than 30 dB in patients with
otitis media with effusion present for greater
than three months.
On May of 2004, the American Academy of Pediatrics Subcommittee on
Otitis Media with Effusion; American Academy of Family Physicians; American
Academy of Otolaryngology--Head and Neck Surgery printed guidelines for the treatment of
otitis media with effusion.
They recommended the following in children age 12 years and under:
View Abstract
1) Ear tube surgery is indicated for otitis
media with effusion that is present for three months that is associated with
a hearing loss.
2) More promptly evaluate and intervene in children with speech, language or
learning problems.
3) Intervene if structural abnormalities of the eardrum or middle ear
develop.
4) Hearing tests should be performed on children with
otitis media with effusion
present for 3 months or longer.
--Initial management consists of ear tube
placement, adenoidectomy should not be performed initially unless another
indication for adenoidectomy exists.
--Repeat surgery consists of adenoidectomy with myringotomy (with or with
out tube insertion.) 3. Poor response to antibiotics for
otitis media.
4. Impending
mastoiditis
or
intracranial
complications due to
otitis media.
5. Recurrent episodes of
acute otitis media
(more than 3 episodes in
6 months or more than 4 episodes in 12 months).
6. Chronic retraction of
tympanic membrane
or
pars flaccida
. This may form a retraction
pocket of the eardrum which may eventually form a
cholesteatoma.
7.
Barotrauma
.
8.
Autophony
(hear body sounds such as breathing)
due to
patulous
(wide open)
eustachian tube.
9.
Craniofacial
anomalies that predispose
to middle ear dysfunction (e.g.
cleft Palate
).
10. Middle ear dysfunction due to head and neck radiation and skull
base surgery. {Note some feel that radiation therapy is a relative
contraindication, because of a possible higher incidence of chronic
infection which can lead to osteoradionecrosis (death of bony tissue due to
radiation) . }
Relative
Contraindication
1.
Radiation therapy to the ear, brain or
nasopharynx.
At least Three articles
have been published which mention (in the abstract) an increased incidence
of persistent
otorhea in patients with
nasopharyngeal
carcinoma
that had been treated with radiation therapy. One abstract reported a 28%
incidence of discharging
otorhea at the time of the last visit.
View Abstract
The following abstracts question if ear tubes
should be inserted in patients who have had radiation to the
temporal bone.
View Abstract
View Abstract
This abstract just mentions the problem of chronic
otorhea after ear tube placement following radiation
therapy to the head.
View Abstract
Go Back To Ear Tube Placement Information Page
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