Ref (type)	Population	Outcome, Interventions	Results and statistical analysis	Effect size	Favours
Recurrence
Systematic review	148 children aged <3 years 2 RCTs in this analysis	Proportion of children with at least 1 episode of AOM 6 months 40/85 (47%) with tympanostomy 51/63 (81%) with control	OR 0.18 95% CI 0.08 to 0.42	Large effect size	tympanostomy
RCT	44 children, aged 9 months to 7 years, with bilateral recurrent AOM of equal severity in each ear despite >3 months of antibiotic prophylaxis	Mean number of episodes of AOM 6 months 0.6% with tympanostomy tube insertion into a randomly selected ear 1.8% with contralateral ear receiving either no surgery or myringotomy alone Absolute numbers not reported	Difference in mean number of episodes: –1.2 95% CI –2.2 to –0.9	Effect size not calculated	tympanostomy
RCT	44 children, aged 9 months to 7 years, with bilateral recurrent AOM of equal severity in each ear despite >3 months of antibiotic prophylaxis	Mean number of episodes of AOM 18 months 0.8% with tympanostomy tube insertion into a randomly selected ear 0.8% with contralateral ear receiving either no surgery or myringotomy alone Absolute numbers not reported	Difference in mean number of episodes 0% 95% CI –0.3 to +0.3		Not significant
RCT	44 children, aged 9 months to 7 years, with bilateral recurrent AOM of equal severity in each ear despite >3 months of antibiotic prophylaxis	Recurrent ear infections with tympanostomy tube insertion into a randomly selected ear with contralateral ear receiving either no surgery or myringotomy alone Absolute results not reported	P = 0.3 The RCT reported a non-significant trend towards more recurrent infections and worse hearing in ears that had received tympanostomy tubes, which became apparent after tube extrusion		Not significant