Postoperative management of pediatric tympanostomy tubes: a Yo-IFOS consensus

Nicolien van der Poel^#^{1

2}, Alberto Maria Saibene^#³, François Simon^{4

5}, Jerome R Lechien⁶, Randa Al-Barazi⁷, Ahmed Alkhateeb⁸, Joana Ximenes Araújo⁹, Maria R Barillari¹⁰, Ricardo Bartel¹¹, Maryana B Cherkes¹², Sharon Cushing¹³, Stéphane Gargula¹⁴, Giannicola Iannella¹⁵, Carolyn M Jenks^{16

17}, Tal Marom¹⁸, Quentin Mat¹⁷, Erika Mercier¹⁹, Eric Moreddu²⁰, Federica Parisi²¹, Shazia Peer²², Jeyasakthy Saniasiaya²³, Natacha Teissier²⁴, Vincent Van Rompaey^{25

26}, Antonino Maniaci²⁷

Affiliations

¹ Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium. Nicolien.vanderpoel@uza.be.
² Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium. Nicolien.vanderpoel@uza.be.
³ Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, 20121, Italy.
⁴ Université Paris Cité, UFR de Médecine, Paris, France.
⁵ Department of Pediatric Oto-Rhino-Laryngology and Head & Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
⁶ Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
⁷ Pediatric Otolaryngology Head and neck surgery, American University of Beirut Medical Center, Beirut, Lebanon.
⁸ Department of Otolaryngology, College of Medicine, King Fahad hospital of University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
⁹ Hospital de Cascais, Lisboa, Portugal.
¹⁰ Audiology and Phoniatrics Unit, Luigi Vanvitelli University, Naples, Italy.
¹¹ Otolaryngology Department, Althaia Manresa University Hospital, Central University of Catalonia (UManresa - UVic), Barcelona, Spain.
¹² Department of Otorhinolaryngology & Head and Neck Surgery, Medical University of Graz., Graz, Austria.
¹³ Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada.
¹⁴ Department of Otolaryngology, Hôpital Fondation Adolphe de Rothschild, Paris, France.
¹⁵ University of Rome, Sapienza, Italy.
¹⁶ Department of Otorhinolaryngology and Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi, Belgium.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Tal Marom, Ashdod, Israel.
¹⁹ Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, USA.
²⁰ Department of Pediatric Otorhinolaryngology- Head & Neck Surgery, La Timone Children's Hospital, APHM, Aix- Marseille Univ, Marseille, France.
²¹ University of Catania, Catania, Italy.
²² Division of Otorhinolaryngology, Head and Neck Surgery, University of Cape Town, Cape Town, South Africa.
²³ Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
²⁴ Pediatric Otolaryngology Department, Robert Debré Hospital, Paris-Cité University, Paris, France.
²⁵ Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
²⁶ Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
²⁷ Department of Otolaryngology, Kore University, Enna, Italy.

^# Contributed equally.

PMID: 40579482
DOI: 10.1007/s00405-025-09485-8

Postoperative management of pediatric tympanostomy tubes: a Yo-IFOS consensus

Nicolien van der Poel et al. Eur Arch Otorhinolaryngol. 2025 Nov.

. 2025 Nov;282(11):5613-5622.

doi: 10.1007/s00405-025-09485-8. Epub 2025 Jun 27.

Authors

Affiliations

¹ Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium. Nicolien.vanderpoel@uza.be.
² Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium. Nicolien.vanderpoel@uza.be.
³ Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, 20121, Italy.
⁴ Université Paris Cité, UFR de Médecine, Paris, France.
⁵ Department of Pediatric Oto-Rhino-Laryngology and Head & Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
⁶ Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
⁷ Pediatric Otolaryngology Head and neck surgery, American University of Beirut Medical Center, Beirut, Lebanon.
⁸ Department of Otolaryngology, College of Medicine, King Fahad hospital of University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
⁹ Hospital de Cascais, Lisboa, Portugal.
¹⁰ Audiology and Phoniatrics Unit, Luigi Vanvitelli University, Naples, Italy.
¹¹ Otolaryngology Department, Althaia Manresa University Hospital, Central University of Catalonia (UManresa - UVic), Barcelona, Spain.
¹² Department of Otorhinolaryngology & Head and Neck Surgery, Medical University of Graz., Graz, Austria.
¹³ Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada.
¹⁴ Department of Otolaryngology, Hôpital Fondation Adolphe de Rothschild, Paris, France.
¹⁵ University of Rome, Sapienza, Italy.
¹⁶ Department of Otorhinolaryngology and Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi, Belgium.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Tal Marom, Ashdod, Israel.
¹⁹ Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, USA.
²⁰ Department of Pediatric Otorhinolaryngology- Head & Neck Surgery, La Timone Children's Hospital, APHM, Aix- Marseille Univ, Marseille, France.
²¹ University of Catania, Catania, Italy.
²² Division of Otorhinolaryngology, Head and Neck Surgery, University of Cape Town, Cape Town, South Africa.
²³ Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
²⁴ Pediatric Otolaryngology Department, Robert Debré Hospital, Paris-Cité University, Paris, France.
²⁵ Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
²⁶ Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium.
²⁷ Department of Otolaryngology, Kore University, Enna, Italy.

^# Contributed equally.

PMID: 40579482
DOI: 10.1007/s00405-025-09485-8

Erratum in

Correction: Postoperative management of pediatric tympanostomy tubes: a Yo-IFOS consensus.
Poel NV, Saibene AM, Simon F, Lechien JR, Al-Barazi R, Alkhateeb A, Araújo JX, Barillari MR, Bartel R, Cherkes MB, Cushing S, Gargula S, Iannella G, Jenks CM, Marom T, Mat Q, Mercier E, Moreddu E, Parisi F, Peer S, Saniasiaya J, Teissier N, Rompaey VV, Maniaci A. Poel NV, et al. Eur Arch Otorhinolaryngol. 2025 Nov;282(11):5623-5624. doi: 10.1007/s00405-025-09622-3. Eur Arch Otorhinolaryngol. 2025. PMID: 40836164 No abstract available.

Abstract

Purpose: Ventilation tube (VT) insertion is the most common surgical procedure in children, but there is known significant variation in post-operative management regimens. This Clinical Consensus Statement (CCS) aimed to establish an evidence-based framework for the follow-up management of children with VT.

Methods: Consensus was sought using a modified Delphi protocol among 23 international otolaryngologists (16 otologists and 7 pediatric otolaryngology specialists) of the IFOS (World ENT Federation). Forty statements were assessed by a 9-point Likert scale through a systematic literature review and three rounds of survey. The consensus level was rated as strong (mean ≥ 8.00, no outliers), consensus (mean ≥ 7.00, ≤ 1 outlier), near consensus (mean ≥ 6.50, ≤ 2 outliers), or no consensus.

Results: Nineteen out of 23 panelists scored the two Delphi rounds. From the 34 original statements, 4 reached strong consensus, 19 reached consensus, 4 reached near consensus, and 7 failed to reach consensus. The highest level of agreement was achieved regarding chronic otorrhea management, patient education protocols, and surveillance of retraction pockets. Different follow-up approach for short, intermediate and long tubes was proposed by the panel.

Conclusions: This CCS provides novel, evidence-based, comprehensive guidance for post-operative management of VT. The recommendations underscore individualized care with special emphasis on patient education and surveillance for complications.

Keywords: Otitis media; Pediatric otolaryngology; Postoperative management; Tympanostomy tubes.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: The authors have no potential conflicts of interest to report pertaining to this study. The authors received no funding for this article or related research. Ethical approval was not required because the study did not involve any patient-related data. All authors have contributed to the consensus paper and have given consent for publication for the final version of this work.

References

1. Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC et al (2022) Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg 166:S1–55 - PubMed
1. Kay DJ, Nelson M, Rosenfeld RM (2001) Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg 124:374–380 - PubMed - DOI
1. Bhattacharyya N, Shay SG (2020) Epidemiology of pediatric tympanostomy tube placement in the united States. Otolaryngol Head Neck Surg 163:600–602 - PubMed - DOI
1. Vlastarakos PV, Nikolopoulos TP, Korres S, Tavoulari E, Tzagaroulakis A, Ferekidis E (2007) Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications? Eur J Pediatr 166:385–391 - PubMed - DOI
1. Mandel EM, Rockette HE, Bluestone CD, Paradise JL, Nozza RJ (1992) Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion. Pediatr Infect Dis J 11:270–277 - PubMed - DOI

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Postoperative management of pediatric tympanostomy tubes: a Yo-IFOS consensus

Affiliations

Postoperative management of pediatric tympanostomy tubes: a Yo-IFOS consensus

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous