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- Richard M. Rosenfeld
- Department of Otolaryngology State University of New York Downstate Medical Center Brooklyn New York USA
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- Seth R. Schwartz
- Department of Otolaryngology Virginia Mason Medical Center Seattle Washington USA
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- Melissa A. Pynnonen
- Department of Otolaryngology University of Michigan Ann Arbor Michigan USA
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- David E. Tunkel
- Department of Otolaryngology—Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
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- Heather M. Hussey
- Department of Research and Quality Improvement American Academy of Otolaryngology—Head and Neck Surgery Foundation Alexandria Virginia USA
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- Jeffrey S. Fichera
- The Ear, Nose, Throat & Plastic Surgery Associates Winter Park Florida USA
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- Alison M. Grimes
- Department of Otology, Head and Neck Surgery UCLA Medical Center Los Angeles California USA
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- Jesse M. Hackell
- Pomona Pediatrics Pomona New York USA
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- Melody F. Harrison
- Department of Speech and Hearing Sciences UNC School of Medicine Chapel Hill North Carolina USA
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- Helen Haskell
- Mothers Against Medical Error Columbia South Carolina USA
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- David S. Haynes
- Neurotology Division, Otolaryngology and Hearing and Speech Sciences Vanderbilt University Medical Center Nashville Tennessee USA
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- Tae W. Kim
- Department of Anesthesiology Johns Hopkins University Baltimore Maryland USA
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- Denis C. Lafreniere
- Division of Otolaryngology UCONN Health Center Farmington Connecticut USA
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- Katie LeBlanc
- Cochrane IBD Review Group London Ontario Canada
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- Wendy L. Mackey
- Connecticut Pediatric Otolaryngology Yale University School of Medicine New Haven Connecticut USA
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- James L. Netterville
- Department of Otolaryngology—Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA
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- Mary E. Pipan
- Trisomy 21 Program, Developmental Behavioral Pediatrics Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
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- Nikhila P. Raol
- Department of Otolaryngology Baylor College of Medicine Houston Texas USA
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- Kenneth G. Schellhase
- Department of Family and Community Medicine Medical College of Wisconsin Milwaukee Wisconsin USA
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説明
<jats:sec><jats:title>Objective</jats:title><jats:p>Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type.</jats:p></jats:sec><jats:sec><jats:title>Purpose</jats:title><jats:p>The primary purpose of this clinical practice guideline is to provide clinicians with evidence‐based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes.</jats:p></jats:sec><jats:sec><jats:title>Action Statements</jats:title><jats:p>The development group made a <jats:italic>strong recommendation</jats:italic> that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made <jats:italic>recommendations</jats:italic> that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months’ duration; (2) clinicians should obtain an age‐appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should reevaluate, at 3‐ to 6‐month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (5) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (6) clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (7) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (8) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow‐up schedule, and detection of complications; (9) clinicians should not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes. The development group provided the following <jats:italic>options</jats:italic>: (1) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) and symptoms that are likely attributable to OME including, but not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life and (2) clinicians may perform tympanostomy tube insertion in at‐risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for 3 months or longer (chronic OME).</jats:p></jats:sec>
収録刊行物
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- Otolaryngology–Head and Neck Surgery
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Otolaryngology–Head and Neck Surgery 149 (S1), 2013-07
Wiley