AAO12: Tympanostomy Tubes: Topical Ear Drop Monotherapy for Acute Otorrhea+

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High Priority Status: Yes / Appropriate Use

CBE Number: N/A

Measure Description:

Percentage of patients aged 6 months to 12 years of age at the time of the visit with a current diagnosis of an uncomplicated acute tympanostomy tube otorrhea (TTO) who were prescribed or recommended to use topical antibiotic eardrops and NOT prescribed systemic (IV or PO) antibiotics for acute TTO

Instructions:

This measure is to be submitted a minimum of once per performance period for patients diagnosed with uncomplicated acute otorrhea after tympanostomy tube insertion. This measure may be submitted by clinicians based on the measure-specific denominator coding.

Denominator:

All patients aged 6 months through 12 years of age at the time of the visit with a current diagnosis of an uncomplicated* acute** TTO

* Uncomplicated refers to TTO that is not accompanied by high fever (38.5°C, 101.3°F), concurrent illness requiring systemic antibiotics (e.g., streptococcal pharyngitis, bacterial sinusitis), or cellulitis extending beyond the external ear canal to involve the pinna or adjacent skin

** Acute refers to less than four weeks’ duration

Denominator Note:

To meet the denominator criteria, a patient must have had tympanostomy tube insertion and an office visit for uncomplicated acute otorrhea within the performance period.

Denominator Exclusions:

None

Denominator Criteria:

Patients aged 6 months to 12 years

AND

Procedure: Tympanostomy Tube

 AND

 Diagnosis: Otorrhea

AND

Patient Visit: Encounter Visit

AND NOT

Conditions: Complicated TTO

OR

Bacterial Infectious Agents

For a list of codes that qualify as denominator eligible visits, reference Addendum attached.

Numerator:

Patients who were prescribed or recommended to use topical antibiotic eardrops and NOT prescribed systemic (IV or PO) antibiotics for acute TTO

Numerator Note:

To meet the intent of the measure, the numerator quality action must be performed at the encounter in which the active diagnosis of uncomplicated acute otorrhea is documented.

Definition:

• Prescribed – prescription given to the patient (guardian) for topical antibiotic eardrops at time of diagnosis.
• Not prescribed – prescription not provided to the patient (guardian) for systemic (IV or PO) antibiotics at time of diagnosis of otorrhea, or within 10 days of diagnosis if otorrhea is not resolved after use of topical antibiotic eardrops.

Denominator Exceptions:

Medical reason(s) for not prescribing/recommending topical antibiotic monotherapy or for prescribing oral antibiotics include:

• Patients with high fever;
• Patients with cellulitis of the ear or adjacent skin;
• Patients who are immunocompromised;
• Patients with oral antibiotic given for other concurrent condition including but not limited to streptococcal pharyngitis, bacterial sinusitis, pneumonia, pharyngitis, osteitis abscess, or other concurrent acute infection beyond the confines of the ear canal;
• Patients who failed topical antibiotic therapy;
• Patients with a cochlear implant;
• Patients with concurrent diabetes.
• Patients who were prescribed oral antibiotics by another clinician; concurrent diagnosis of acute suppurative otitis media with effusion with intact eardrum; acute TTO persists, or worsens, despite topical antibiotic therapy.

Patient reason(s) for not prescribing/recommending topical antibiotics or prescribing oral antibiotics include:

• Administration of eardrops is not possible because of local discomfort;
• Lack of tolerance

Measure Classifications:

• Submission Pathway: Traditional MIPS
• Measure Type: Process
• High Priority Type: Appropriate Use
• Meaningful Measures Area: Appropriate Use of Healthcare
• Care Setting(s): Ambulatory Care: Clinician Office/Clinic
• Includes Telehealth: Yes
• Number of Performance Rates: 1
• Inverse measure: No
• Continuous measure: No
• Proportional measure: Yes
• Ratio measure: No
• Risk Adjusted measure: No

Clinical Recommendation Statement:

Clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea.

Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngology Head Neck Surg. 2013;149(1 Suppl):S1-S35. doi:10.1177/0194599813487302

 Rationale:

Otorrhea is the most common sequela of tympanostomy tubes; most otorrhea is sporadic, brief, and relatively painless, with recurrent otorrhea affecting only about 7% of patients and chronic otorrhea occurring in about 4%. Topical ear drops resolved the ear drainage (OME) 3 to 5 days faster and resulted in more clinical cures overall -85 percent for those taking the drops vs 59 percent for those on oral administration of antibiotics

UT Southwestern Medical Center. Antibiotic Ear Drops Favored Over Popular Oral Antibiotics for Ear Infections. ScienceDaily. 2006. Available at: www.sciencedaily.com/releases/2006/12/061213104143.htm

 Supporting Clinical Practice Guideline (CPG):

For more details, reference the Clinical Practice Guideline: Tympanostomy Tubes in Children (Update) [2022]

 © 2026 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.

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The measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The measure and specifications are provided “as is” without warranty of any kind. Neither the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF), nor its members shall be responsible for any use of the measure. The AAO-HNSF and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

Addendum