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Affiliation
1 Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York 11201, USA. richrosenfeld@msn.com
Richard M Rosenfeld et al. Otolaryngol Head Neck Surg. 2013 Jul.
Affiliation
1 Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York 11201, USA. richrosenfeld@msn.com
Objective: Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type.
Purpose: The primary purpose of this clinical practice guideline is to provide clinicians with evidence-based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes. ACTION STATEMENTS: The development group made a strong recommendation that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made recommendations that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration; (2) clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (5) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (6) clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (7) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (8) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (9) clinicians should not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes. The development group provided the following options: (1) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) and symptoms that are likely attributable to OME including, but not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life and (2) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for 3 months or longer (chronic OME).
Keywords: developmental delay disorders; grommets; middle ear effusion; otitis media; otorrhea; pediatric otolaryngology; tympanostomy tubes.
Rosenfeld RM, Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA, Lieberthal AS, Mahoney M, Wahl RA, Woods CR Jr, Yawn B; American Academy of Pediatrics Subcommittee on Otitis Media with Effusion; American Academy of Family Physicians; American Academy of Otolaryngology--Head and Neck Surgery. Rosenfeld RM, et al. Otolaryngol Head Neck Surg. 2004 May;130(5 Suppl):S95-118. doi: 10.1016/j.otohns.2004.02.002. Otolaryngol Head Neck Surg. 2004. PMID: 15138413
Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD. Rosenfeld RM, et al. Otolaryngol Head Neck Surg. 2016 Feb;154(1 Suppl):S1-S41. doi: 10.1177/0194599815623467. Otolaryngol Head Neck Surg. 2016. PMID: 26832942
Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, Grimes AM, Hackell JM, Harrison MF, Haskell H, Haynes DS, Kim TW, Lafreniere DC, LeBlanc K, Mackey WL, Netterville JL, Pipan ME, Raol NP, Schellhase KG. Rosenfeld RM, et al. Otolaryngol Head Neck Surg. 2013 Jul;149(1):8-16. doi: 10.1177/0194599813490141. Otolaryngol Head Neck Surg. 2013. PMID: 23818537
American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. American Academy of Family Physicians, et al. Pediatrics. 2004 May;113(5):1412-29. doi: 10.1542/peds.113.5.1412. Pediatrics. 2004. PMID: 15121966 Review.
Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I. Lous J, et al. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001801. doi: 10.1002/14651858.CD001801.pub2. Cochrane Database Syst Rev. 2005. PMID: 15674886 Updated. Review.
Haapanen M, Renko M, Artama M, Manninen IK, Mattila VM, Uimonen M, Ponkilainen V, Kuitunen I. Haapanen M, et al. Laryngoscope Investig Otolaryngol. 2021 Jul 15;6(4):878-884. doi: 10.1002/lio2.622. eCollection 2021 Aug. Laryngoscope Investig Otolaryngol. 2021. PMID: 34401516 Free PMC article.
Al-Salim S, Tempero RM, Johnson H, Merchant GR. Al-Salim S, et al. Ear Hear. 2021 Mar 26;42(5):1195-1207. doi: 10.1097/AUD.0000000000001038. Ear Hear. 2021. PMID: 33974785
Niedzielski A, Chmielik LP, Stankiewicz T. Niedzielski A, et al. Int J Environ Res Public Health. 2021 Mar 30;18(7):3555. doi: 10.3390/ijerph18073555. Int J Environ Res Public Health. 2021. PMID: 33808050 Free PMC article.
Sabir OA, Johnson EG, Hafiz AE, Nelson RN, Hudlikar M, Sheth I, Daher NS. Sabir OA, et al. Int J Pediatr. 2021 Feb 13;2021:6688991. doi: 10.1155/2021/6688991. eCollection 2021. Int J Pediatr. 2021. PMID: 33628279 Free PMC article.
Savarirayan R, Tunkel DE, Sterni LM, Bober MB, Cho TJ, Goldberg MJ, Hoover-Fong J, Irving M, Kamps SE, Mackenzie WG, Raggio C, Spencer SA, Bompadre V, White KK; on behalfof the Skeletal Dysplasia Management Consortium. Savarirayan R, et al. Orphanet J Rare Dis. 2021 Jan 14;16(1):31. doi: 10.1186/s13023-021-01678-8. Orphanet J Rare Dis. 2021. PMID: 33446226 Free PMC article.

Child pornography is pornography that exploits children.[1] It is against the law in many countries.[2] Child pornography is most often made by taking pictures or videos,[1] or more rarely[3] sound recordings,[4] of children who are wearing less clothing than usual, wearing no clothing, or being raped. It can also be made using illustrations of children. Child pornography is sometimes called "child sexual abuse images" because it is images (pictures) of a child who is being sexually abused.[1] Child pornography can be made by setting up a camera or other recording device and molesting a child.
Child pornography can also be drawn,[5] written,[6][7][8] or created by a computer.[9] In that case, it is called "simulated child pornography",[10] "virtual child pornography",[11] "non-photographic child pornography", or "pseudo-photographic child pornography":[12] the child in the pornography is simulated, virtual, or drawn, meaning the child is not real.[10][11][13]
There are several possible reasons for a person to look at child pornography. The most common is that the viewer is a pedophile, hebephile, or ephebophile who finds minors sexually attractive and uses pornography featuring minors to induce arousal.[14] Viewers may be curious about the subject.[15] Or a person who plans to commit statutory rape may plan to show the pornography to a minor as a form of grooming to convince the minor that minors having sex with adults is normal.[16] Mexico is the largest distributor of child pornography in the world.[17]
Between 2016 and 2018, many countries made their child pornography laws more similar, which let police from different countries work together more easily. In particular, the word "child" in the new child pornography laws is used as a synonym for legal minors under the age of 18.[2] This can be confusing because "child" usually means a person who has not yet reached puberty. However, in 2007, the United States already had laws forbidding pornography with models under 18, and most people who were arrested for owning child pornography around that time had images of children who have not started puberty.[18]
Some countries consider virtual or non-photographic child pornography which depict children who are not real to be a type of child porn that is illegal, whereas other countries do not consider this type of child porn illegal. Making this type of child porn illegal has been controversial. This is due to multiple reasons: due to the opinion that it is pointless to protect children who are not real,[19] the opinion that such laws remove people of their rights,[20] a fear that these laws can cover harmless material,[21] and the fear that it is possible to exploit such laws to charge harmless individuals with heavily disproportionate charges.[22] Another criticism that is often given to the illegal nature of pornographic depiction of fictional children is the assertion that removing a potential a paedophile's ability to access an alternative to the "real thing" will encourage them abuse real children. Research on whether this is true or not has produced mixed results.[23][24]
In England due to a 2009 act, basically all non-photographic child pornography is illegal, even if it is something unrealistic, such as an anime drawing. However, charges for unrealistic non-photographic child porn possession or creation which do not involve real children tend to get dismissed by judges at trials and are not treated overly seriously.[25]
The Internet is a common place for people to share child pornography, especially on the dark web.[26][27] When police officers find child pornography on the Internet, it is difficult for them to track down the molester and the other people who have looked at the recording.[26]
Child molestation is when an adult touches a child in the genital area (between the legs), buttocks, or breasts, or a child is made to touch an adult in those areas. An adult touching any part of a child's body without consent (permission) from the child is also sometimes called molestation. Molestation is very harmful to children and can traumatize them for years or for the rest of their lives.[28] An adult recording an instance of molestation as child pornography also harms the child. This harm from the recording is added to the harm from the molestation itself. Knowing that the molestation was recorded can slow down the child's healing from the abuse. The adult who has the recording can sell the recording, or threaten to share it with other adults to scare the child in the recording and make them obey the adult.[29][30]
Content is available under CC BY-SA 3.0 unless otherwise noted.

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