Tubes just as good as meds for ear infections

A new study examines treatment options for otitis media in a post-pneumococcal vaccine cohort.

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Children with recurrent ear infections do just as well with grommets as on antibiotics when it comes to holding off bouts of infection, a recent study suggests.

A US study of over 200 children with recurrent otitis media aged six to 35 months found there were no significant differences between the half who were assigned tympanostomy tube placement and the half who underwent medical management over the two-year duration of the study. 

At the conclusion of the trial, no significant differences were found between the two groups in terms of episodes of acute otitis media, as well as no increased antimicrobial resistance in the medical management group.

“Differences that we did find favouring children in the tympanostomy tube group concerned the time to a first episode of acute otitis media, various clinical findings related to the occurrence of episodes, and the percentage of children meeting specified criteria for treatment failure; however, children in the medical management group had fewer cumulative days with otorrhea,” the authors wrote in the NEJM.

The researchers commented the findings were of particular interest as the cohort involved young children all of whom had been immunised against pneumococcal disease.

Most studies which evaluated tympanostomy tube placement were conducted before the introduction of the vaccine and historically pneumococcus was the most frequent cause of otitis media.

“Previously, most children who had problems with pneumococcal infections were really sick, but we see fewer of these because of the vaccine,” Dr Elizabeth Rose, a paediatric ENT specialist at the Royal Children’s Hospital Melbourne, told The Medical Republic.

However, otitis media in young children is still common with data from late last year suggesting three-quarters of Australians have at least one episode of otitis media by school age, with the infection being most common in six- to 18-month-olds.

“Kids can have a really bad year of contracting the infection when they start coming into contact with other children,” Dr Rose said.

According to the NEJM study authors, the opinions on the most effective means of treating recurrent otitis media in children still vary.

“Official recommendations regarding tympanostomy tube placement for children with recurrent acute otitis media differ — an otolaryngologic guideline recommends the procedure for children with recurrent acute otitis media, provided that middle-ear effusion is present in at least one ear; a contemporaneous paediatric guideline discusses tympanostomy tube placement as an ‘option [that] clinicians may offer’,” the researchers wrote.

And while grommets are often thought to be superior to medical management in terms of preventing the consequences associated with recurrent infections, the drawbacks include the cost and the risks associated with anaesthesia.

Despite these, Dr Rose told TMR she would likely continue to recommend tympanostomy tubes for infants with recurrent ear infections.

“The main reason that we would put tubes in very young children is because of pain,” she said.

“When we get a child who is in a lot of pain, we often say ‘look, we can put in a tube to relieve the pressure and pain, but the child will still get infections which can then be treated’.”

NEJM, 2021 May 13