Ear infections and the dreaded tubes
After umpteen visits to the doctor to treat your child’s ear infections, your pediatrician recommends surgery. The doctor wants to insert pressure-equalizing tubes in the little tyke’s eardrums to prevent fluid from accumulating in the middle ear. But the thought of surgery scares you.
Should you take your doctor’s advice? Or should you insist on more of the bubble gum-flavored amoxicillin, one of the most frequently prescribed antibiotics to treat otitis media, or middle-ear infection?
Medical experts say pressure-equalizing tubes are most effective in youngsters who have persistent fluid in both ears for at least three months, or in one ear for six months. The fluid buildup can lead to hearing loss and, in extreme cases, brain abscesses or meningitis.
Tubes are also recommended for children who have had at least one ear infection a month, for four or five consecutive months, and for kids who don’t respond to the antibiotics.
Even then, some doctors are reluctant to go with the surgery.
“I’m pretty conservative about placing tubes,” said Dr. Jeffrey Hoffman, chief of otolaryngology at Kaiser Permanente. “If I see someone who meets the criteria, but we’re getting into the warmer months, then I put off placing tubes.”
Experts say parents also might want to hold off on the surgery if the child is nearing grade school. Ear infections are most common among toddlers younger than 3 who attend day care. Most youngsters outgrow them by age 6.
If the parent decides to have the outpatient surgery, here’s what will happen:
The child will be put to sleep with anesthesia.
A surgeon will make a tiny incision in each eardrum, drain the fluid and insert a clear plastic tube, about 2 millimeters (the width of a grain of rice) in diameter, in each hole. The surgery takes about 15 minutes.
Although children with tubes rarely have ear infections, the surgery has a downside.
While the procedure is one of the top three causes of hospitalization for children between ages 1 and 4, anytime a general anesthetic is administered, a patient is at risk. Parents should make sure the anesthesiologist has experience in pediatric anesthesiology.
The other downside is that tubes can be short-lived.
“One of the frustrating things for parents is they put the tubes in and then they come out,” said Dr. Randy Barfield, an Atlanta pediatrician.
The culprit is often fluid or wax from the ear canal. So doctors can’t know for sure whether the tubes will stay in for two weeks or several months. Tubes almost always fall out on their own. Under the best of circumstances, they remain in the ears for about 12 to 18 months.
Obviously the best advice is to try to avoid ear infections entirely. But that doesn’t mean working parents should yank their children out of day care centers and move to a glass bubble.
Physicians recommend treating upper respiratory infections with decongestants or antihistamines to improve eustachian tube function. Humidifiers can also relieve congestion.
Avoiding exposure to the flu and other viral illnesses also can prevent ear infections.
