Do Tympanostomy Tubes for OME Prevent Hearing Loss?

Clinical Question

Do ventilation tubes prevent hearing loss in children who have otitis media with effusion (OME)?

Evidence-Based Answer

In children with typical hearing and language development, immediate placement of tympanostomy tubes for OME does not improve important long-term outcomes compared with a period of watchful waiting and placement of tubes only if there is no improvement.

Practice Pointers

Children who have OME present with a middle ear effusion but no signs or symptoms of infection. It is thought that because this effusion causes a hearing loss of 20 to 30 decibels (dB) it may negatively impact future hearing and language development. However, because OME is extremely common (affecting an estimated four out of five children before they reach four years of age) and significant speech and hearing problems are rare, the impact of OME may not be so easily determined.

Lous and colleagues performed a systematic review of the literature for randomized controlled trials that compared tympanostomy tubes with no tubes and that included only children who did not have a speech or language delay at baseline. Thirteen studies were identified; randomization varied from ears (e.g., a tube was placed in the right ear but not the left), to time period (immediate insertion of bilateral tubes or a period of watchful waiting), to treatment (adenoidectomy or no adenoidectomy). In three studies, all children underwent adenoidectomy.

In most studies, tubes improved hearing in the short term (about 9 dB at six months and 4 dB at two years). The benefit was attenuated in children who also underwent adenoidectomy (3 to 4 dB at six months and no difference at two years). Differences in speech or language development were minimal or nonexistent. Studies on the adverse effects of tubes are limited but suggest that children given tubes may experience a small long-term hearing loss (mean of 2 to 7 dB) compared with children who have a similar severity of OME but are not given tubes.

Room Air vs. Oxygen for Resuscitating Infants at Birth

Clinical Question

Does using 100 percent oxygen for neonatal resuscitation increase morbidity and mortality?

Evidence-Based Answer

Based on limited evidence, it appears that mortality is lower in infants resuscitated with room air than in those given 100 percent oxygen. However, these results should be treated with caution because one fourth of studies used back-up supplementary oxygen.

Practice Pointers

Because excessive oxygen can increase free radical levels and decrease cerebral blood flow, it is thought that it may increase ischemic injury. Many deliveries occur outside of hospitals, where access to oxygen supplementation is limited. In hospital deliveries, early cord clamping often is performed to bring the newborn closer to an oxygen source for resuscitation. Delayed cord clamping has been shown to be beneficial in preterm infants to allow perfusion after delivery.1

Tan and colleagues reviewed the literature to determine whether neonatal resuscitation with room air improves outcomes compared with 100 percent oxygen. They found five randomized and quasirandomized studies including 1,302 infants in total. A reduction in death rate was evident for infants resuscitated with room air (number needed to treat = 20). One study found that infants given room air had better five-minute Apgar scores; however, the difference was small and there were no significant differences in 10-minute Apgar scores or rates of grade 2 or 3 hypoxic ischemic encephalopathy. Another meta-analysis2 came to similar conclusions.

Based on current evidence, 100 percent oxygen should be used with caution during neonatal resuscitation. Routine use of oxygen should not supersede interventions with known benefit such as delayed cord clamping. Evidence supports the routine use of room air.