Table 3.
Appropriateness of tympanostomy tube placement* in sample of indications rated by expert panel (otitis media with effusion)
| Indications | Duration of current middle ear effusion† | ||||
|---|---|---|---|---|---|
| <60 days | 60-90 days | 91-120 days | 121-180 days | >180 days | |
| No hearing test and: | |||||
| 1. No antibiotics for the effusion | Inappropriate | Inappropriate | Inappropriate | Inappropriate | Uncertain |
| 2. One or more courses of antibiotics | Inappropriate | Inappropriate | Inappropriate | Uncertain | Uncertain |
| Normal hearing test and: | |||||
| 3. No antibiotics for the effusion | Inappropriate | Inappropriate | Inappropriate | Uncertain | Uncertain |
| 4. One or more courses of antibiotics | Inappropriate | Inappropriate | Inappropriate | Uncertain | Uncertain |
| Unilateral abnormal hearing test and: | |||||
| 5. No antibiotics for the effusion | Inappropriate | Inappropriate | Uncertain | Uncertain | Appropriate |
| 6. One or more courses of antibiotics | Inappropriate | Inappropriate | Uncertain | Uncertain | Appropriate |
| Bilateral abnormal hearing test (mild) and: | |||||
| 7. No antibiotics for the effusion | Inappropriate | Inappropriate | Uncertain | Appropriate | Appropriate |
| 8. One or more courses of antibiotics | Inappropriate | Uncertain | Appropriate | Appropriate | Appropriate |
| Bilateral abnormal hearing test (moderate to severe) and: | |||||
| 9. No antibiotics for the effusion | Inappropriate | Inappropriate | Appropriate | Appropriate | Appropriate |
| 10. One or more courses of antibiotics | Inappropriate | Uncertain | Appropriate | Appropriate | Appropriate |
The table shows a sample of 2240 clinical scenarios developed and rated for children with otitis media with effusion. Other clinical scenarios for otitis media with effusion incorporated variables such as duration of unilateral effusion, age of patient, presence of speech delay, otoscopic findings, history of otitis media, and impact of otitis media on family. Each numbered row represents five possible clinical scenarios.
*In patients with bilateral persistent otitis media with effusion, no history of middle ear disease before the current episode, age less than 3 years, no speech delay, absence of marked otoscopic findings, and absence of severe disruption of family life.
†Refers to consecutive days of effusion directly preceding surgery.