Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.
This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.
Advice
Middle ear ventilation tubes (MEVT) should not be used as the first-line of treatment for children who have middle ear disease.
When is the procedure indicated?
MEVTs are indicated when first-line treatments have not been successful or are contraindicated.
Other potential indications for MEVT include:
- otitis media with effusion (OME) in children who are at risk for speech, language or learning problems, regardless of hearing status
- tympanic membrane changes (for example, atelectatic ear disease)
- persistent OME-associated hearing loss with a hearing threshold of ≥ 40 dB
- bilateral OME for ≥ three months, unilateral OME for ≥ six months or recurrent episodes of OME with cumulative duration of OME for ≥ six of the previous 12 months
- complications of acute otitis media.
Best care recommendations
A child should be regularly reviewed by their healthcare practitioner to monitor and manage middle ear disease. First-line treatment options should be offered, which initially includes a period of observation.
If symptoms do not resolve, a combination of medical therapies and simple therapies (depending on the clinical presentation) should be trialled.
If first-line treatments have been trialed unsuccessfully or are contraindicated, a referral to a specialist for further management is indicated.
Evidence
Department of Health. Section D: Medical management of otitis media. Canberra (ACT): Australian Government; 2020. [cited 2020 Jun 25].
National Institute for Health and Care Excellence. Otitis media with effusion in under 12s: surgery. London (UK): National Institute for Health and Care Excellence; 2018 [cited 2020 Jun 29].
Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Colborn DK, Bernard BS, et al. Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. New England Journal of Medicine. 2001 Apr 19;344(16):1179-87.
Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngology—Head and Neck Surgery. 2013 Jul;149(1_suppl):S1-35.
Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al. Clinical practice guideline: otitis media with effusion executive summary (update). Otolaryngology–Head and Neck Surgery. 2016 Feb;154(2):201-14.