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

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.