When should I consider tubes for my children? Tube placement has been done since 1954. Note, placement of tubes may reduce the severity, number, complications from recurrent otitis media. However, tubes are not a cure all. There are specific criteria for when tubes should be considered. 1. recurrent ear infections: 3 in 6 months or 4 in 12 months, especially despite the use of prophylactic antibiotics. Here are the 2004 guidelines on the diagnosis and management of acute otitis media by the American Academy of Family Practice and the American Association of Pediatrics. 2. complicated ear infections, meaning that tissues beyond the middle ear are affected by the infection. 3. otitis media with effusion, called OME, meaning persistent fluid in the middle ear without signs of infection. Here are joint published guidelines from family practitioners, pediatricians, and ear-nose-throats physicians. Tubes should be placed in moderate hearing loss persists. 4. The presence of disorders of hearing or balance (middle and inner ear functions), structural disorders (cleft palate, Down's syndrome), or other developmental disorders may predispose patients to recurrent or unusually severe cases of otitis media. Early placement of tubes may reduce the severity, number, complications from recurrent otitis media.