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.