I received another email via our iPhone App from a mom who had read the ear infection articles and asked about the placement of ear tubes. That is a great question as this topic comes up often in children who have frequent ear infections.

ear2The placement of tympanostomy tubes (“tubes”) in the ear drums for recurrent otitis media (ear infections) has been studied a great deal over the last 10 years. Tympanostomy tube placement is a surgical procedure that places a small tube into the eardrum to ventilate the area behind the eardrum.  These tubes also equalize the pressure in the middle ear.

There are around 2 million tympanostomy tubes place in children in the U.S. each year due to chronic and recurrent ear infections.

The most common time for a child to have ear tubes placed is between 6 months and 2 years of age.   When a child has an ear infection it typically follows an upper respiratory infection and  fluid accumulates behind the ear drum and may become infected.  This infection is routinely treated with antibiotics.  In some cases a child’s ear infection does not clear despite the use of numerous antibiotics, or a child may develop recurrent ear infections with each cold they get.

Lastly, it is very common for a young child to continue to have fluid behind the ear drum (serous otitis) which may last for weeks to months. Each of these scenarios may be a reason for your doctor to refer you to an ENT (ear, nose and throat) doctor for “tube” placement.

Placing tympanostomy tubes helps prevent recurrent ear infections by allowing air into the middle ear.  The tube also drains the fluid that had accumulated behind the ear drum.   It had previously been the consensus that early tube placement would also prevent hearing loss that might occur due to persistent fluid resulting in possible language delays.

In recent years two articles in the New England Journal of Medicine looked at whether early tube placement vs later tube placement resulted in differences in language and cognitive development in children.  In both of these studies, there was no difference in language or cognitive development at either 3 or 9 years of age between  the two groups.

There is not one answer to the decision to place tubes.  Each case for tympanostomy tube placement should be looked at on an individual basis.  Not only should the number of ear infections be considered (often more than 5-6 in a season), but the age of the child may also be important,  as younger children are more prone to frequent infections.

In my opinion it is also important to look at the time of year the infections are occurring,  as a group of children will often clear up frequent infections and  persistent fluid once spring and summer months are upon us.  Again, delaying tubes for several months while deciding the appropriate course for your child has not been shown to cause developmental or language delays.

If your child is having recurrent ear infections discuss tympanostomy tube placement with both your pediatrician and a pediatric ENT.

That's your daily dose for today.  We'll chat again tomorrow.

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