Medical decision analysis: Indications for tympanostomy tubes in RAOM by age at first episode

OBJECTIVE: To compare utility estimates between tympanostomy tubes (TT) and short-courses of antibiotics in children with recurrent acute otitis media (RAOM) stratified by age at first episode. STUDY DESIGN AND SETTING: Formal decision analysis. RESULTS: The model recommended TT sooner in children with a history of a first episode of AOM occurring early in life. In children over 12 months old at onset. TT were recommended with seven episodes in 24 months, five episodes in 12 months, and three episodes in six months. In children under six months old at onset, TT were recommended with three episodes in 24 months and two episodes in a six-month or 12-month time span. CONCLUSIONS: Earlier TT may be indicated in children who developed a first episode of AOM at a very young age because of the higher risk of AOM recurrence. SIGNIFICANCE: This study is the first formal decision analysis to compare tympanostomy tubes and short-courses of antibiotics stratified by age at onset of the first AOM episode. (C) 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.