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Original Investigation
November 2016

Perioperative Hearing Evaluations for Patients Undergoing Tympanostomy Tube Placement

Author Affiliations
  • 1Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts
  • 2Harvard Medical School, Department of Otology and Laryngology, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2016;142(11):1070-1074. doi:10.1001/jamaoto.2016.1980
Key Points

Question  Are current American Academy of Otolaryngology–Head and Neck Surgery guidelines regarding perioperative hearing evaluations for tympanostomy tube (TT) placement supported by clinical data?

Findings  In this pediatric case series, postoperative hearing loss was observed in some TT recipients; however, there was no instance of postoperative hearing loss in the setting of healthy ears and no comorbidities following a normal preoperative hearing result.

Meaning  Postoperative hearing evaluation should be completed after TT placement to determine resolution of a preoperative hearing loss but may not be necessary following normal preoperative test results.


Importance  Obtaining hearing thresholds is an important step in the evaluation of a child with otitis media because decreased hearing in the presence of a chronic middle ear effusion factors into the decision to place tympanostomy tubes (TTs).

Objective  To provide evidence regarding appropriate use of perioperative hearing evaluations in conjunction with TTs.

Design, Setting, and Participants  Case series with medical record review of all patients aged 0 to 24 years who received TTs at a tertiary pediatric care facility from June 1, 2010, through June 1, 2011. Medical records were abstracted by 1 researcher for surgical, audiometric, tympanometric, clinical, and patient demographic data. The data analysis was performed between December 1, 2014, and June 1, 2015.

Main Outcomes and Measures  Audiometric data were examined to determine the number of patients with hearing loss preoperatively and postoperatively, with the intention to describe the population with no prior hypothesis regarding results.

Results  Of 2274 patients identified, 910 (40.0%) were female. Median (interquartile range) age at TT placement was 2.62 (1.48-4.94) years. A total of 1757 (77.3%) underwent audiometric evaluation preoperatively, 1742 (76.6%) postoperatively, and 1395 (61.3%) both preoperatively and postoperatively; 170 (7.5%) had no audiometric testing. Within 1 year after surgery, 271 (11.9%) of patients had evidence of nonfunctional tubes. Postoperatively, 19.9% (347 of the 1742 patients who received a postoperative evaluation) had hearing loss. In all, 89 (3.9%) patients had a permanent sensorineural hearing loss, and 15 (0.66%) had a persistent conductive hearing loss.

Conclusions and Relevance  A postoperative audiometric examination should be performed in children who have hearing loss when evaluated before TT placement to determine whether resolution of the hearing loss was obtained.