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Another Ear Infection? Time For Tubes?

Did you know that the number one reason children have surgery or anesthesia in the United States is for ear tubes? (Store that random trivia for your next dinner party conversation). With tubes being so common, you may have questioned whether or not your child should get tubes (the official name is tympanostomy tubes). Tympanostomy tubes are surgically placed when the Eustachian tubes you are born with don’t work very well. When you are young, the Eustachian tubes often don’t drain very well (they are small, have a sharp angle, or are easily clogged). The tympanostomy tubes just create another avenue for the fluid to drain out.

In years past, there was a lot of inconsistency about who did or didn’t get recommended for tubes, which probably had more to do with how aggressive your doctor was than anything else. However in 2013, an official practice guideline (trying to standardize recommendations for docs) was issued by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (say that 3 times fast) on tympanostomy tubes. Here’s the abbreviated take home version for you.

Consider tubes if your child has:

  1. Frequent infections: At minimum 3 infections in 6 months or 4 infections in a year (as an aside, in the community where I practice, most ENTs will also use 5 total as a definitive number, although that is not part of the official guidelines).
  2. Infections that don’t get better with antibiotics: These are the infections you have attempted to clear with 3 or 4 different oral antibiotics and may end up getting antibiotic shots to clear up.
  3. Fluid in the middle ear space (normally it is just air) for more than 3 MONTHS (the medical term is otitis media with effusion) AND there is impaired hearing or the fluid is causing problems like balance issues or pain.
  4. Fluid in the middle ear space that is not likely to resolve quickly and your child is HIGH RISK (child has Down syndrome, cleft palate, permanent hearing loss, speech/language delay, etc.).

While surgery should never be taken lightly, placement of tubes is generally very simple and quick. Usually the anesthesiologist uses a mask to put your child to sleep (they don’t usually intubate or put a tube down their throat). The ENT (Ear, Nose, and Throat surgeon) who does the surgery is usually sitting and only takes 2-3 mins per side to place the tubes. The tube is tiny (typically 0.05 inch in diameter) and falls out in 1 to 2 years (sometimes they will only last a few months though before falling out). It is not uncommon to have to have a second set put in.

According to the practice guidelines, if your child already has tubes:

  1. He or she can bathe or swim without having to use specific precautions (e.g. ear plugs, headbands), in most cases.
  2. If an infection develops, drops alone can be used to treat the infection, eliminating the additional need for oral antibiotics.

If you are still uncertain whether or not your child should have tubes, ask your pediatrician. Your pediatrician knows you and your child and can steer you in the right direction.