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Probes and Tips - June 2009 - Otoacoustic Emissions (OAE) Screening for Children with Pressure Equalization (PE) Tubes

the National Center for Hearing Assessment and Mangement

This newsletter provides TIPS to enhance your OAE screening and follow-up practices and PROBES about current activities so we can learn from one another's successes and challenges. Check out our website for more helpful resources: www.infanthearing.org/earlychildhood

June, 2009 issue

Tip of the Month

Otoacoustic Emissions (OAE) Screening for Children with Pressure Equalization (PE) Tubes


Among many good questions we’ve received from newsletter readers, we’ve gotten several inquiries about PE tubes, including when they should be recommended and whether OAE screening can and should be conducted with children who have PE tubes. 

Q: When do children need Pressure Equalization (PE) tubes? Should children with PE tubes be screened?

A: Otitis media (OM) is inflammation of the middle ear and is very common in childhood with the average toddler having several episodes a year, almost always accompanied by an upper respiratory infection (URI).  OM has many degrees of severity and there are two main reasons why PE tubes (sometimes called tympanostomy tubes) may be recommended: 1) Fluid has accumulated in the middle ear for several months causing some degree of temporary hearing loss; 2) Multiple ear infections have been noted that are severe and could not be adequately controlled with other treatments.

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More specifically, Clinical Practice Guidelines issued in 2004 state that clinicians should:

 . . .1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME [otitis media with effusion]; 2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and 3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). . . 4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; 5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and 6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. (American Academy of Family Physicians, American Academy of Otololaryngology-Head and Neck Surgery, and American Academy of Pediatrics Subcommittee on Otitis Media With Effusion, Clinical Practice Guideline: Otitis Media With Effusion, available at http://www.aafp.org/online/en/home/clinical/clinicalrecs/otitismedia.html)

During tube insertion, a young child is typically placed under light, general anesthesia, a small incision is made in the eardrum, fluid is suctioned out, the tube is put in, and in most cases hearing sensitivity returns to normal.  The added aeration of the middle ear reduces the recurrence of acute OM.  No procedure is usually necessary to remove the tube—after a period of time (approximately 6 – 24 months) it will become dislodged naturally and fall out.   Some children will have to have a tube replaced if it falls out too soon or become plugged. 

A child with PE tubes should be able to pass the OAE screening if the tube is open and functional. (Note that some screening equipment requires the screener to make an adjustment when screening children with PE tubes.)  If a child with PE tubes does not pass the OAE screening, he/she should be referred to a health care provider for a middle ear evaluation to determine whether the tube is in place, is clear, and is functioning as it should.   

Here is a “real life” experience related by one program conducting OAE screening:  I had a mom call me to have her son rescreened. We had several "refer" readings after he was enrolled. He finally had tubes placed and was advancing quickly with language. One of the tubes fell out and mom wanted me to come recheck the child. We did get a "refer" on the ear that lost the tube, so that gave mom something to take back to a doctor who told her "not to worry about it." She was so happy to have our services to assist her. I wrote a letter to the doctor today asking for a follow-up medical exam. It is nice to have parents seek us out to test when they have concerns.

This is a great example of how a program is appropriately using their OAE equipment to help children get the medical attention they need.   Even though the health care provider felt that there was nothing to worry about, the Head Start program was able to conduct an OAE screen that indicated that there may still be a problem requiring further treatment or monitoring.

Probe of the Month

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