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CPG: Tympanostomy Tubes in Children (Update) – Research Needs

CPG: Tympanostomy Tubes in Children (Update) – Research Needs

Research Needs section from Tympanostomy Tubes in Children CPG


  1. Can we identify clinical factors that predict persistence of MEE in children who present with effusions of short duration?
  2.  What is the ideal timing of audiologic testing for a child being considered for tubes–before surgery, after surgery, or both?
  3.  If resources are limited, and audiologic testing is done only after tube placement, how will this affect surgical decision making or counseling about “permanent” hearing loss diagnosed only after surgery?
  4. Are there any caregiver questions, in addition to the two proposed in this CPG, that can predict hearing difficulties and quantify severity, without formal audiologic testing, in patients considered for tubes?
  5. Can we identify the children with OME and speech/language delays who will benefit from tympanostomy tube placement?
  6. What is the relationship of MEE and balance abnormalities, and how do these balance abnormalities change after tympanostomy tube placement?
  7. Are there behavioral problems that correlate with the presence and duration of middle ear fluid problems, and can we screen for these problems in children who have OME?
  8.  What is the best time to evaluate children referred for possible surgical treatment of recurrent AOM with relation to the last episode of AOM?
  9. Can we quantify the predictive value of presence of middle ear fluid in one or both ears for likelihood of more episodes of AOM in children with a history of recurrent AOM?
  10. What are the benefits of tympanostomy tube placement on frequency of AOM, prevalence of OME, and speech/language development for children in specific at-risk populations?
  11. Does tympanostomy tube surgery present unique risks or greater complications in some of the at-risk groups?
  12.  What is the actual frequency of AOM and prevalence of OME in specific at-risk groups?
  13. Is there the potential for underdiagnosis of OME because of attention to other conditions, or over-diagnosis of OME because of greater clinical exposure, for some of the at-risk populations?
  14.  How strongly is abnormal tympanometry at initial clinical encounter associated with persistence of OME?
  15. What are the clinical indicators that best predict the need for repeated tympanostomy tube placement?
  16. What is the role of allergy testing in children with recurrent tube otorrhea or a need for repeated tympanostomy tube placement, and can managing allergy, if present, result in beneficial outcomes?
  17. Are there certain types of long-term tubes that are more often associated with complications such as granulation or otorrhea?
  18. Which subgroups of children should be considered for adenoidectomy at the time of the first set of tubes or when younger than age 4 years?
  19. How do “face-to face” counseling, written materials, and online resources best inform parents and caregivers and facilitate shared surgical decision making?
  20. What are the indications to prescribe postoperative ototopical antibiotics at the time of surgery?
  21. Will the incidence of postoperative otorrhea, and the causative microbiology, change with adoption of the recommendation to limit routine drop use after surgery?
  22. Are there predictors for failure of ototopical therapy as initial treatment for TTO?
  23. Can we identify the children at risk for otorrhea, as well as other clinical indicators for post tympanostomy water precautions?
  24. To what extent can recommendations regarding water precautions for children with tympanostomy tubes be generalized to adults with tympanostomy tubes?
  25. What is the ideal follow-up schedule for examining patients with tubes?
  26. How often should children be assessed in primary care settings, and, how often should children be assessed by otolaryngologists, after tympanostomy tubes are placed?
  27. How often should hearing be formally assessed after tympanostomy tubes are placed?
  28.  What is the duration of intubation that is associated with eardrum complications if the tube is not removed?
  29. If a child has a retained tympanostomy tube for more than three years and has normal hearing, an otherwise normal eardrum, and no symptoms, should the tube be removed or is additional observation a preferred option?
  30. If the decision is made to remove a retained tympanostomy tube, when should a myringoplasty be performed?
  31. If a myringoplasty is performed at time of tube removal, is there a preferred artificial or autograft material for this repair?
  32. What is the best management for an asymptomatic child with normal hearing who on examination has a tympanostomy tube that is medialized into the middle ear behind an intact eardrum?
  33. Are there differences in access to surgical treatment of otitis media, as well as differences in surgical decision making, across socioeconomic, ethnic, and racial groups?
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