Table 3.

Clinical Practice Guideline Variation

Clinical Practice Guideline	Representative text	Corresponding Guideline Information
Duration of tube function	“Short- term tubes … typically stay in place for six to eighteen months…. Long-term tubes are larger and have flanges that secure them in place for a longer period of time.”32 “These ventilating tubes remain in place for six months to several years.”33 “Tympanostomy tubes generally remain in the eardrum for six months to two years, with T-tubes lasting up to four years.”34	“Parents/caregivers of children with tympanostomy tubes should be given information regarding longevity of the tympanostomy tubes. This will vary depending on the type of tube that is placed (short-term versus long-term tubes). Short-term tubes generally last 10 to 18 months, but long-term tubes typically remain in place for several years.”
Follow-up schedule†	“An initial follow-up appointment will be scheduled within the first two to four weeks after the procedure. Other follow-up appointments…will be scheduled at four- to six-month intervals”.35 “Follow-up visits…. Are very important. The doctor checks to see whether the tubes are working and whether the child’s hearing has improved.”36 Your doctor may recommend a follow-up examination 7–14 days after the procedure. Further appointments are typically scheduled every 3–6 months…”.37	“Generally, the child should be evaluated periodically by an otolaryngologist while the tympanostomy tubes are in place. After extrusion, an additional follow-up appointment with the otolaryngologist should occur to ensure the ears are healthy and to identify any need for further surveillance or treatment. “
Detection of complications‡	“Medical attention may be necessary… If the child has experienced several ear infections…The child has persistent ear drainage after using the drops as ordered. The child has increasing ear pain without ear drainage…. If any significant change of hearing is noted”.37 “If the drainage persists or if there is fever greater than 102F, an office visit may be necessary…”.38 “Otorrhea…- This is treated initially with antibiotic ear drops; occasionally, children experience persistent ear tube drainage that necessitates prompt removal of the tube”.39	‘…. parents/caregivers should be counseled that TTO may occur, responds to topical antibiotic ear drops, does not usually require oral antibiotics, and benefits from water precautions until the discharge is no longer present.”
Water precautions §	“Your surgeon might recommend earplugs for regular bathing or swimming.”40 “…usually you don’t have to worry about protecting the ears with an earplug unless your child is dunking their head deeply (over a couple of feet below the surface) or the water is not thought to be clean.”41 “Current guidelines do not recommend routine water precautions”.32	“Water precautions are unnecessary for most children with tympanostomy tubes but should be implemented for children who develop TTO or experience discomfort upon exposure to water. Protection with earplugs, headbands, or water avoidance may be necessary during periods of active TTO.”

^†Not mentioned on two websites.

^‡Not mentioned on two websites.

^§Not mentioned on two websites.