As parents, we’ve all been there. Long, late nights with a screaming toddler suffering from a fever as he or she tugs on ears — another ear infection and another trip to the pediatrician. If your child has this problem frequently, you probably have heard the doctor mention that tubes might be needed. But what do ear tubes entail, and are they safe?
The most common reasons for placing ear tubes are recurrent ear infections and fluid that remains behind the ear drum. More than 80 percent of children have at least one episode of ear infections by the time they are 3 years old. Infections in the middle ear tend to occur after an upper respiratory infection, usually viral in nature.
Ear infections account for more than 30 million doctor visits a year and are more frequent in children between 6 months and 3 years of age. A pediatrician will usually refer your child to a pediatric ear, nose and throat specialist when the frequency exceeds three ear infections in six months or five in a year. In addition, if your child’s pediatrician notices fluid in the ears that does not appear to be resolving, he or she might refer for a formal evaluation of hearing and consideration of ear tubes.
There are a number of reasons your child might have recurrent ear infections. One possibility is that the antibiotics did not fully kill all the bacteria that created the first ear infection. Another possibility is that a virus was responsible for the ear infection and antibiotics are unable to eradicate it. This is why most patients have been on multiple types of medications before ear tubes are considered.
Your child might also have a structural problem with the ear, where the space inside the eardrum is not well aerated. A small passage leading from the middle ear to the back of the nose — called the Eustachian tube — equalizes the air pressure between the middle ear and the outside world. When a child develops an upper respiratory viral illness, the lining of the nose and throat becomes swollen, including the lining of the Eustachian tube. This swelling increases the likelihood of an ear infection.
When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is bacterial. Pressure from this buildup pushes on the eardrum and causes pain, and because the eardrum cannot vibrate, the child may experience temporary hearing loss. As children grow, the anatomy of the Eustachian tube changes and function improves. This is one reason children usually outgrow ear infections.
If you are referred to a pediatric ear, nose and throat doctor, a hearing test will likely be performed. This will clarify how remaining fluid in the ears is impacting your child’s hearing. This is of particular concern in children with speech problems, as it can delay acquiring new vocabulary, and it can be problematic for children with articulation difficulty.
Frequent ear infections and fluid in the ears have been shown to have a direct impact on the development of language, affecting academic performance. If there is hearing loss, your child will have difficulty following conversations. Hearing aids are not the solution in the majority of cases because hearing can be easily restored once the fluid is removed through ear tubes.
The surgery to place ear tubes usually lasts 20 minutes. During the procedure, a small incision is made in the eardrum, any fluid is suctioned out and the tubes are placed. After surgery, your child can return to his or her daily activities later that day.
The tubes allow air to enter through the middle ear and also allow any fluid to drain behind the eardrum. The size of the tube is slightly larger than the tip of a pen. The tubes usually remain in place six to 18 months and fall out by themselves.
While the tubes are in place, ear infections can be easily treated with ear drops. Also, the presence of the tiny hole in the eardrum from the tube doesn’t impair hearing. In fact, kids with a speech or language delay from hearing loss often will see a normalization of their hearing.
Although there is still disagreement among physicians, most agree that children with ear tubes can swim and enjoy water activities without restrictions. The few kids who do develop repeated drainage after water activities may benefit from the use of earplugs.
If you suspect your child’s ear infections are becoming an ongoing problem, talk to your pediatrician about seeing an ear, nose and throat doctor. A minor outpatient surgery could be the key to ending your child’s pain and your sleepless nights.
Leonardo Torres, M.D., is a pediatric ear, nose and throat specialist at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.