Otitis Media Management

Introduction to Grommet Insertion

The American Academy of Otolaryngology-Head and Neck Surgery recommends bilateral tympanostomy tube insertion in children with bilateral otitis media with effusion (OME) for 3 months or longer and documented hearing difficulties 1
The American Academy of Otolaryngology-Head and Neck Surgery guidelines also recommend bilateral tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who have unilateral or bilateral middle ear effusion at the time of assessment 1
Bilateral grommet insertion is recommended in most clinical scenarios involving children with otitis media, according to the 2013 and 2022 clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery 1, 2

The decision for unilateral versus bilateral insertion should consider the presence of effusion in one versus both ears, hearing status in each ear, history of recurrent infections in one versus both ears, and anatomical considerations that might contraindicate placement in one ear 1, 2
Undertreating bilateral disease by inserting grommets in only one ear when both ears have chronic effusion may leave persistent hearing loss and infection risk in the untreated ear 1, 2
Unnecessary anesthesia exposure may occur if unilateral tubes are placed initially but the contralateral ear later requires treatment, necessitating a second anesthetic procedure 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery guidelines emphasize bilateral insertion in most clinical scenarios, based on the natural history of otitis media, the goal of optimizing hearing and reducing recurrent infections in children, and the need for a single anesthetic procedure 1, 2