Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media

In intention-to-treat analysis (n=250; age 6-35 months), the rate of episodes of acute otitis media during a 2-year period was not significantly lower with tympanostomy-tube placement than with medical management (mean 1.48 vs 1.56 episodes per child/year, respectively; p=0.66).

SPS commentary:

An editorial notes that although frequency of episodes of acute otitis media was similar in the two groups, a significant difference was observed in a per-protocol analysis (1.47 vs. 1.72, respectively), and it might be expected that qualitatively the episodes of acute otitis media were substantially different between the two groups. It adds that despite this, the results of this trial are very useful for shared decision making with caregivers; they can be informed that:

  • the present course of medical management may be continued with no greater likelihood of antimicrobial resistance than if a surgical option is selected.
  • In a child older than 2 years of age, it is predicted that infections will be fewer in the coming year and that medical treatment should be continued.
  • In the younger child, there is a nearly 50% likelihood that the frequency of infections will continue; the child is likely to have fewer and less severe episodes of acute otitis media with less exposure to antibiotics if tympanostomy-tube placement is undertaken, with only occasional development of persistent otorrhoea.

New England Journal of Medicine

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Editorial