| A: Ear, nose and throat surgeons use ear tubes as a last resort for the treatment of persistent middle ear fluid associated with hearing loss. These tiny plastic tubes drain fluid that has been trapped in the middle ear and also allow air to enter the middle ear. This air normally passes into the middle ear through the Eustachian tube, which often becomes blocked during colds, ear infections, and in some children with nasal allergies.
The Eustachian tube is the tiny connection between the back of the nose and the middle ear. Its tiny size and flat angulation in infants and young children make it more vulnerable to obstruction leading to the increased number of bacterial and viral ear infections that are plaguing so many children. As the child grows, the Eustachian tube structure also changes resulting in the marked decrease in ear infections and fluid build up problems in older children which occurs around the age of 5 years. Ear tubes help buy time.
In most instances, the fluid usually goes away with watchful waiting. It is common for fluid to persist in the middle ear for 2-3 months after the ear infection has been treated successfully with antibiotics.
We now refer to 2 types of ear infection, acute otitis media (AOM) for the acute infection, and otitis media with effusion (OME) for the fluid build up type.
The concern about persisting fluid is the hearing loss, which may impair language development. Because tubes are controversial and require general anesthesia, guidelines have been developed to help decide when these tubes are indicated. It is critical for patients to discuss the benefits and risks to make sure that tubes are used for the children who really need them.
Otitis Media Guideline Panel Recommendation for Placement of Tubes
- For fluid that has persisted for over 3 months in both ears
- Associated with significant hearing deficit
Tubes usually remain in place for approximately one year. If they fall out prematurely, they may need to be replaced. Rarely, if they are still present after several years, the ENT specialist will need to remove them. Special instructions are needed for patients to avoid immersion in water, such as when swimming.
While there are benefits of tubes, such as return of hearing to normal and a reduction in the recurrence of ear infection, there are also risks. Sometimes tubes don’t make a difference. There is the risk of general anesthesia, as with any other surgical procedure. There may also be infection around the tubes and scarring of the eardrum in the place of insertion when the tubes are removed. In any given child, the risks of doing the procedure should outweigh the risks of not doing it.
| -- Take Home Message -- |
| While controversial, ear tubes have a role in the treatment of recurrent ear infections where the fluid persists in both ears for greater than 3 months and is associated with significant hearing loss. There are benefits for those children who really need them, but there are also risks. Benefits, expectations and risks should be discussed in detail with the primary care clinician and ear, nose and throat specialist for informed consent. Importantly, there is no such thing as a minor surgical procedure where general anesthesia is concerned. |
|
