Provider Practices and Perspectives on Ototopical Medication Use After Tympanostomy Tube Placement

Sunday, October 18, 2026

1:36 PM - 1:42 PM PT

Location: 409AB

Presenting Author(s)

SC

Shayna Portanova Cooperman, MD

Resident Surgeon
Stanford University
Stanford, California, United States

Co-Author(s)

AJ

Alexandria M. Jensen, PhD

Senior Biostatistician
Stanford University Quantitative Sciences
Palo Alto, California, United States
LN

Lacey Nelson, MD

Resident Surgeon
Stanford University, United States
Grace S. S. Kim, MD

Assistant Professor
Stanford University
Stanford, California, United States
ML

M Lauren Lalakea, MD

Adjunct Professor
Stanford Medicine
Los Altos, CA, United States

Senior Author(s)

KM

Kara D. Meister, MD

Assistant Professor
Stanford Medicine
Stanford, CA, United States

Disclosure(s):

M Lauren Lalakea, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The 2022 AAO-HNS/F Tympanostomy Tubes in Children Clinical Practice Guideline (Update) (CPG22) recommended against routine postoperative prescription of antibiotic ear drops after tympanotomy tube placement, yet they are still commonly prescribed. This study investigates provider beliefs and practices to better characterize the current state of perioperative antibiotic ear drop use.

Methods: An 18-question anonymous cross-sectional survey was electronically distributed to American Society of Pediatric Otolaryngology members from October 2025 to January 2026. The survey assessed prescribing practices across middle ear findings (dry/scant effusion, serous or mucoid effusion, and active infection), intraoperative and postoperative drop selection, and factors influencing decision-making. Data were analyzed using descriptive statistics and Sankey plots.

Results: 155 members completed the survey (22.5% response rate), most of whom were fellowship-trained pediatric otolaryngologists at academic institutions. 71% of respondents reported prescribing antibiotic drops intraoperatively and postoperatively often or almost always. Antibiotic drop use was influenced by concern for early tube plugging/extrusion (73.6%) and postoperative otorrhea (40.6%). Routine drop use varied by middle ear status: dry (50.3%), serous (69.0%), and mucoid (80.7%). Only 28.4% reported changing their use of antibiotic drops following CPG22. Comfort omitting postoperative drops was highest for dry ears (65.2%) and lowest for mucoid effusions (14.5%). Potential motivations for reducing antibiotic use included antibiotic stewardship (57%), guideline evidence (56%), and environmental sustainability (22%)

Conclusions: Despite updated guidelines, most surveyed pediatric otolaryngologists routinely use perioperative ototopical antibiotics. Tympanostomy tube plugging/extrusion remains the dominant concern driving prophylactic drop use. Comparative effectiveness studies evaluating tube obstruction and extrusion rates across ototopical regimens are needed to further guide practice.