Surgical Management Options

The primary surgical therapy for chronic otitis media remains placement of tympanostomy tubes for pressure equalization and drainage of the middle ear space. Numerous publications have demonstrated the efficacy of tympanostomy tubes for the treatment of chronic otitis media with effusion and recurrent otitis media.38,40-43 The Academy of Otolaryngology, in its 1995 Clinical Indicators Compendium,44 listed the following indications for placement of tympanostomy tubes: (1) middle ear effusion present for 3 months or more; (2) otitis media with effusion associated with hearing loss of > 30 db; (3) chronic severe tympanic membrane retraction; (4) impending intracranial complications associated with otitis media; and (5) recurrent otitis media with more than three episodes within a 6-month period, or more than four episodes within a 12-month period. It should be emphasized that these indications are guidelines and a decision to place tympanostomy tubes should be individualized for each patient, based on their particular situation. Because of the increasing prevalence of resistant bacteria in communities around the United States, there may be a role for earlier placement of myringotomy tubes in situations of recurrent acute otitis media and chronic otitis media with effusion to avoid long-term antimicrobial therapy.

Other surgical options may be considered in children with chronic otitis media. Adenoidectomy has clearly been demonstrated as a useful adjunctive surgical procedure that may decrease the incidence of otitis media. This procedure may performed with myringotomy alone, or with myringotomy and placement of tympanostomy tubes.45-49 Adenoidectomy should be considered for children with chronic otitis media who are candidates for tym-panostomy tube placement and who have symptoms of chronic adenoid hypertrophy, such as hyponasal speech and chronic mouth-breathing. Adenoidectomy should also be considered in children requiring multiple sets of tympanostomy tubes, regardless of symptomatology, as it has been demonstrated that adenoidectomy may accelerate the resolution of chronic otitis media regardless of the size of the adenoid pad.50,51

Finally, the recently publicized Otolam laser-assisted myringotomy has been advocated as a treatment option for the management of chronic otitis media with effusion. This may provide immediate symptomatic relief and potentially avoid placement of tympanostomy tubes. This may be performed under local anesthesia in the office setting. No long-term studies have been performed to investigate this particular treatment modality. However, clinical trials are currently in progress.

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