New Ear Tubes – November 9, 2023
A 33-month-old female presents to the emergency department (ED) for an “ear check.” The child recently had ear tubes placed and has just finished a course of antibiotic drops prescribed by her Otolaryngologist (ENT). She had been doing well until the evening of presentation when she spiked a “fever” to 100.1oF. The family is leaving in the morning for a beach vacation and given her medical history, want to make sure she has not developed another ear infection. The child’s parents deny fussiness, nor have they noted any drainage from either ear. In the ED she is afebrile and has normal vital signs. Her Wispr exam is shown below. The remainder of her general physical exam is unremarkable.
Which of the following is true regarding the child’s tympanic membrane (TM)?
- The tympanostomy (ear) tube is patent and there is evidence of resolving acute otitis media (AOM).
- The child should be sent back to ENT for evaluation of the tympanostomy tube placement.
- There is evidence of recurring acute otitis media and antibiotics should be considered.
- This child should wear earplugs when in the water at the beach.
Answer: A. The tympanostomy (ear) tube is patent and there is evidence of resolving acute otitis media (AOM)
The child has a patent-appearing tympanostomy tube (ventilation, ear tube) that is well positioned. She has no erythema or bulging to suggest an acute otitis media. There are several mucopurulent “mud” spots on both TMs that suggest she recently had otitis media. The tympanostomy tube is flush with the TM and does not require further ENT evaluation.
According to the 2022 American Academy of Otolaryngology-Head and Neck Su
rgery Practice Guideline update, clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes.
Here is the complete video exam.
Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, Hackell J, Hunter LL, Keppel KL, Kim AH, Kim TW, Levine JM, Maksimoski MT, Moore DJ, Preciado DA, Raol NP, Vaughan WK, Walker EA, Monjur TM.
Otolaryngol Head Neck Surg. 2022 Feb;166(1_suppl):S1-S55
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