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Referring a Child for Tympanostomy Tube Placement: A Predictive Window of Susceptibility Model

January 10, 2023

Tympanostomy tube placement (TTP) remains the most commonly performed pediatric surgical procedure requiring general anesthesia. However, figuring out who needs TTP can be challenging, especially because most cases of otitis media are viral and short lived (thanks to vaccinations). Can we figure out if a child is still within a window of susceptibility to an new infection while recovering from a previous one, in which case TTP might be needed? 

Bajorski et al (10.1542/peds.2022-058556) share with us an analysis of a prospective observational cohort study involving 286 children 6 to 36 months of age in one primary care practice.

This study is unique in that acute otitis media (AOM) was confirmed by tympanocentesis. Once diagnosed, the authors noted that 80% of AOMs occurred between 6 and 21 months of age with 72% of the window of susceptibility intervals being less than 5 months and 97% less than 10 months in duration. They discover that the most significant predictors of which children would fall into the window of susceptibility would be those who have their first AOM in early infancy and who attend day care. The authors provide a predictive table in which you can input a child’s age, daycare attendance, and the number and frequency of AOMs, and then see if that child sits in the window and thus warrants getting TTP.

So is this study convincing enough for you to consider reducing TTP surgery? We invited Drs. Rana El Feghaly and Mary Anne Jackson at Children’s Mercy Kansas City and the University of Missouri Kansas City to comment on the study findings (10.1542/peds.2022-060110). They note the risks and benefits of treating AOM in children over 6 months of age—both with antibiotics as well as with TTP surgery. They also note the strengths of the Bajorski study as well as some limitations to generalizability. They praise the authors for at helping us think more critically with our otolaryngology colleagues of who really needs TTP, enabling us to not only be good stewards of antibiotics in the treatment of AOM but also of this popular surgical procedure. Link to this study and learning more.

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