Tuesday, April 24, 2012

Ear tubes

We’ve just passed April 17, this year’s “Tax Day.” As a pediatrician, I view this day as a clinical milestone, a right of passage: It signals the end of the typical winter illness season! 

Although this past winter was unbelievably mild in the Midwest, we still had our share of common childhood illnesses, including the curse of recurrent ear infections. As one of the more frequent surgeries for children, ear tube surgery is a commonly used tool to minimize the impact of recurrent ear infections. Here are some FAQs worth addressing:
What is the purpose of ear tube surgery?
Ear infections involve infected fluid building up in the “cave” behind the eardrum we call the middle ear space. Two situations lead to most surgeries for tubes.  First is for the child who has recurrent ear infections with little break between them and insufficient help from antibiotics and time. The second is for the child with persistent fluid in this middle ear space. It dampens hearing during a critical time of speech development. As you’d imagine, stagnant fluid behind the eardrum can become infected just like a stagnant farm pond will quickly grow moss. This sometimes occurs because the tube in our ear called the Eustachian tube doesn’t drain away the fluid properly. The tubes take away the stagnant fluid in the middle ear and reduce the risk of infection and normalize hearing.
When should I consider tubes an appropriate option? 
Most experts suggest considering tubes if a young child has recurrent infections or persistent fluid behind the eardrum (especially if hearing is dampened as it often is) after three to six months of ongoing struggle. Many variables can modify this guideline. I’m slower to recommend tubes in the spring since many children have improvement over the summer. If a child can’t clear fluid in July or August, I’d be quicker to recommend tubes since winter illnesses are likely to aggravate the problem. Also, the greater the pain and irritability a toddler has with ear infections, the sooner I’d consider tubes. A child’s speech progression or struggle may also impact my decision. If a family can modify risk factors such as cigarette smoke exposure or daycare attendance, I might delay tube placement and see if the modifications help. Except for treating active infection, no medications have proven to rid the middle ear space of fluid. 
Is the procedure typically helpful and safe? 
Tube placement is one of the most common procedures performed in the U.S. and has a track record of great safety. The benefit of having tubes far outweighs the possible complications for the appropriate candidates. Complications can include infections despite the tubes, scarring of the eardrum, or a persistent hole in the eardrum that doesn’t seal over naturally. These complications are almost always reversible.

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