An end to the pain?
Ear tube surgery helps many kids, but some doctors warn not to rush into it
Friday, August 22, 2008
Pierce Salbego suffered ear infection after ear infection, many requiring more than one round of antibiotics to stop the infection. But when the doctor suggested maintenance antibiotics until he was older, his mother hesitated.
"That didn’t sound like a good idea to us," Cyndi Salbego, of Plainfield, remembers.
She faced the decision of sending her 1-year-old into the operating room for ear tube surgery, where a tiny incision is made in the eardrum and an ear tube is fitted to allow for better drainage. "We pushed for ear tube surgery in hopes that his infections would end without more medication," she says.
Ear infections are so common that practically all children will have had at least one middle ear infection by age 6. Whether the symptoms range from fever to diarrhea to tugging at the ears, most kids feel the pain.
While surgery may be worrisome for parents, ear tube surgery for children has become commonplace. "It is the most common minor outpatient surgery for children in the country," says Dr. Nancy Young, pediatric ear specialist at Children’s Memorial Hospital in Chicago.
When is surgery needed?
Don’t assume that one or two painful ear infections will qualify your child for surgery. An ENT (ear, nose and throat) doctor, or otolaryngologist, will determine if your child is a good candidate for the surgery. Not all doctors agree on when—or if—the surgery should be performed.
"The decision to place ear tubes is complex," says Dr. Charlotte Cowan, pediatrician and author of the Dr. Hippo series of children’s picture books, including The Little Elephant with the Big Earache, which focuses on ear infections.
"The medical literature is replete with conflicting data about whether the placement of tubes decreases the incidence of subsequent ear infections, decreases a child’s need for antibiotics and/or also decreases the problems of hearing loss and speech delay attributed to repeated ear infections. In my experience, the decision to refer a child for surgery proved almost always beneficial, often life changing, but it was not without significant forethought."
Recurrent ear infections are usually the first indication that further examination is warranted. Dr. Andrew Hotaling, a pediatric ENT at Loyola University Health System, studies his patients’ infection history first.
"Three infections in six months or four in 12 months is a big indicator," Hotaling says.
But the infections aren’t the only reason ear tube surgery is a consideration. Some children have chronic fluid in their ears or pain caused by abnormal pressure in the middle ear. Some children also have speech delays that can be directly related to middle ear problems.
Not all doctors agree that ear tube surgery is required for chronic fluid in the ears. Dr. Jack Paradise, professor of pediatrics and otolaryngology at the University of Pittsburgh School of Medicine, published a study in the New England Journal of Medicine in January 2007 that suggests ear tube surgery for fluid does not change the speech or hearing development in children.
At the ENT’s office, your child should be given a thorough examination, including an inspection of the ears, a hearing test and a discussion of your child’s health history. Any allergies or previous surgeries must be disclosed to allow your ENT to make the best possible decision for your child.
What is the surgery like?
Your ENT has suggested surgery, but the thought of sending your child into an operating room still has you concerned. Ear tube surgery is performed under general anesthesia, which has its own risks, but the administration of anesthesia and surgery takes only 15 to 20 minutes.
During the surgery, your ENT will remove any fluid in your child’s ear before making the incision and inserting the tube, which is about the size of your child’s fingertip. Once in the ear, doctors remove the fluids and any build up that may have occurred.
"The day of the surgery, we were nervous," says Salbego, "but it was so quick and we had zero problems."
When your child recovers from the anesthesia, usually within an hour, nurses will give you the all-clear to head home.
With any surgery, risks are involved and, luckily, ear tube surgery’s risks are low. Your doctor should tell you the risks involved at your initial appointment, but Hotaling lists three as being anesthesia, infection and bleeding. In healthy children, these risks are extremely low, particularly if the surgery is performed by a qualified ENT.
What does the future hold?
If hearing was an issue, within hours you may notice a difference in your child. He may startle at unexpected loud noises or respond more quickly to you.
"In the future, you might also notice fewer infections, better balance and improved speech," Hotaling says.
Fewer infections are the key for parents to remember. While ear tubes alleviate the pressure, they don’t stop ear infections altogether. Once the tubes are inserted, antibiotics can be administered directly to the ear through drops instead of taking oral antibiotics, which can cause a multitude of problems if taken too often. The infections should be less frequent and painful for your children and some parents, including Salbego, report a full cessation of ear infections.
A debate rages on about the use of earplugs after surgery. Some doctors claim earplugs should be worn any time a child’s ears are exposed to water, whether in the bathtub or the local pool. Some doctors only recommend earplugs if a child is fully submerged in the water and others only if the child dives to the bottom of a pool where the pressure is stronger. Without a definitive recommendation, parents should follow the advice of their ENT.
So what becomes of the tubes? They will aid in draining any fluid caught in your child’s ear until they are pushed out by the ear’s self-cleaning mechanism, usually within a year or two.
"After the tubes have gone," Young says, "the eardrum almost always seals up on its own. It has a great capacity for healing. If the tube doesn’t push out on its own, the doctor can perform a quick surgery to get it out."
Rarely a second ear tube surgery needs to be performed in children whose tubes have fallen out. As a child grows, his Eustachian tube may have grown or changed enough to allow for normal functioning. But if ear infections remain a problem after the tubes fall out, the doctor may recommend reinserting a new set.
Ear tube surgery isn’t a miracle cure, but in many children’s cases, it relieves the pain and pressure that can interfere in so many facets of their lives.
Michelle Sussman is a mom, wife and writer in Bolingbrook.