OBJECTIVE: In 2022 the American Academy of Otolaryngology (AAO) published updated clinical guidelines for pediatric tympanostomy tube placement. Statement 6 recommended that clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (rAOM) who do not have middle ear effusion (MEE) at the time of evaluation. We performed a 5-year update on a study evaluating this recommendation in our pediatric patient population. STUDY DESIGN: Retrospective cohort study. SETTING: University of Texas Medical Branch. METHODS: Retrospective chart review was performed on children aged 6 months to 12 years diagnosed with rAOM without MEE at the time of assessment. The watchful waiting group (WW) consisted of children who did not receive tympanostomy tubes, while the watchful waiting failure group (BMT) ultimately underwent myringotomy with tube placement. Common rAOM risk factors were assessed between groups. RESULTS: 285 children met inclusion criteria. There was a significant difference in age between groups (WW = 2.62 ± 1.87 years, BMT = 1.79 ± 1.19 years
p <
0.001). There was a 64.2 % success rate for watchful waiting. There was no significant difference in risk factors associated with rAOM between the groups. CONCLUSION: As a 5-year update from a previous study, this study again assesses Statement 6 of the 2022 AAO tympanostomy tube guidelines. The 64.2 % watchful waiting success rate following these guidelines is consistent with the 66 % success rate found at the same institution 5 years prior. Contrary to the previous study, older children were significantly more likely to be successfully observed.