Ear tubes may be unnecessary in some cases, study finds - Healio

Guidelines for receptor infections successful young children whitethorn pb to unnecessary tympanostomy conduit placement, according to a survey published successful Pediatrics.

The survey recovered that recurrent cases of acute otitis media hap successful a constrictive “window of susceptibility” and that galore conduit placements apt hap aft this model has passed. In specified cases, “the cessation of [acute otitis media] is attributed to the country when, successful fact, our information [suggest] the [window of susceptibility] whitethorn person ended and the kid would person experienced an extremity to [the infections] with patience and watchful waiting,” the authors wrote.

“Our extremity is to amended the diagnosis, prevention and attraction of receptor infections successful children,” Michael E. Pichichero, MD, a pediatric infectious illness specializer and manager of the Rochester General Hospital Research Institute, told Healio. “Within that paradigm, we person the contented of erstwhile [a kid needs] to person receptor tubes placed due to the fact that of recurrent receptor infections.”

National guidelines endorsed by the AAP and American Academy of Otolaryngology suggest that a kid becomes a campaigner for tubes pursuing 3 receptor infections successful 6 months, oregon 4 receptor infections successful 12 months.
ased connected that, astir a fractional cardinal kids get tubes each twelvemonth successful the U.S., and it costs implicit a cardinal dollars each year,” Pichichero said. “So, we asked the question: What if we get to that threshold, and the kid does not get their tubes?”

Pichichero and colleagues conducted a prospective cohort survey successful which they enrolled 286 children aged 6 months and followed them until property 5 years, examining the frequence of receptor infections and confirming diagnoses via tympanocentesis.

More than 80% of receptor infections owed to acute otitis media occurred erstwhile children were aged betwixt 6 and 21 months.

“What we recovered is that for implicit 90% of the children, they don't get immoderate much receptor infections [after the archetypal windows], adjacent though they didn't get the tubes,” Pichichero said. “So, their model of susceptibility to receptor infections is simply a batch [narrower] than was realized. [About] 75% of the children who get receptor infections get each of their receptor infections successful astir 5 months, and much than 90% of the kids who get aggregate receptor infections get each the receptor infections they're going to get wrong 10 months.”

In an accompanying commentary, pediatric infectious illness physicians Rana E. El Feghaly, MD, MSCI, and Mary Anne Jackson, MD, from Children’s Mercy Kansas City and the University of Missouri-Kansas City School of Medicine, said the survey could assistance clinicians find children who whitethorn request earlier referral for conduit placement. But they besides noted immoderate remaining questions.

“Would the information beryllium replicated successful a diligent colonisation that is not predominantly white, insured, and with precise debased smoking exposure, a controllable hazard origin for [acute otitis media]?” they asked. “With the alteration successful vaccination rates that we are presently witnessing, volition the epidemiology of [acute otitis media] displacement yet again?

They reminded readers that pneumococcal and influenza vaccines alteration the hazard for acute otitis media.

“While moving to guarantee timely adherence with each vaccinations, catchup vaccinations for those children who person fallen down during the pandemic are essential,” they wrote. “Clinicians should enactment families to modify hazard factors similar baccy exposure, travel strict criteria to diagnose [acute otitis media], sermon the risks of antibiotics erstwhile indicated, and connection watchful waiting erstwhile appropriate.”

“Ear conduit country has needs to beryllium reassessed,” Pichichero said. “It's being recommended acold excessively excessively based connected existent guidelines.”

References:

Bajorski P, et al. Pediatrics. 2023;doi:10.1542/peds.2022-058556.

El Feghaly RE, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060110.