In children with recurrent otitis media or chronic effusion, do tympanostomy tubes decrease further episodes, improve hearing, or improve language acquisition?

Tympanostomy tubes, with or without other interventions, do not produce sustained improved hearing as compared with no treatment, and has not been shown to improve language acquisition, cognitive development, or behavior measures. There might be a small reduction in the recurrence of acute otitis media, but there is little research in this area. Another study of tubes found no long-term (6 years to 9 years) benefit on development (N Engl J Med 2007;356:248-261). (LOE = 1a-)

Steele DW, Adam GP, Di M, Halladay CW, Balk EM, Trikalinos TA. Effectiveness of tympanostomy tubes for otitis media: a meta-analysis. Pediatrics 2017;139(6):e20170125  [PMID:28562283]

Meta-analysis (other)

Government

Various (meta-analysis)

These researchers searched 4 databases, including Cochrane CENTRAL, to find randomized controlled trials and other comparative research studies that evaluated the effectiveness of tympanostomy tubes. They included research written in any language. Citations were selected by 2 independent researchers. Study details were abstracted by one researcher and checked by a second researcher. In 16 randomized controlled trials of treating children with otitis media with effusion, the insertion of tubes with or without adenoidectomy decreased (improved) hearing threshold within the first 1 month to 3 months by an average 9.1 dB to 10.0 dB as compared with no treatment. However, there was no effect on hearing thresholds at 12 months to 24 months for tympanostomy alone or combined with adenoidectomy, prophylactic antibiotic treatment, or myringotomy as compared with no treatment. Overall, there was no effect on cognitive, language, and behavioral outcomes. In 3 small studies of children with recurrent acute otitis media the effect of tympanostomy tubes was inconsistent regarding recurrences. This analysis was a Bayesian network analysis, a statistical approach that still has some kinks in it, and the study report itself was somewhat incomplete, as is the evidence base for this common intervention.