Tuesday, November 12, 2013

4 Myths About Ear Tubes in Children

1. Tubes are bad for kids' ears: FALSE! Tubes are a good option for kids who have frequent ear infections or a chronic build up of fluid behind the eardrum that affects hearing and speech development. Around 670,000 children under age 16 undergo this procedure each year in the US, and by age 3, 1 in 15 children (7%) will have tubes placed. For children in daycare, 15% will need tubes! Insertion of ear tubes is the most common surgery requiring anesthesia performed on children in the US.

Tube placement is safe, effective, and very commonly done. Children under age 7 are at increased risk of ear infections and eardrum fluid because their immune systems are relatively immature and their eustachian tubes don't always open properly to allow air into the space behind the ear drum. Frequent courses of antibiotics can have significant health risks for children, and frequent visits to the family doctor can become burdensome. Ear tubes offer an option for children to avoid ear infections, antibiotics, and hearing and speech complications while their immune systems and eustachian tubes mature. Which brings up the next myth:

2. Tubes cure ear infections: FALSE! Tubes are placed to "bypass" the immature eustachian tube allowing air to enter the eardrum and fluid to drain or evaporate from the space behind the eardrum. Most ear tubes are shaped in such a way that the eardrum pushes the tube out after 6 to 12 months. During the time that the tubes are in place, the space behind the eardrum dries out and the eustachian tube begins to function properly. Once a child's eustachian tubes reliably open (with swallowing, yawning, and other normal motions of the throat), fluid is much less likely to accumulate in the space behind the eardrum.  A dry chamber is much harder to get infected, and with no fluid to impede soundwaves, hearing improves back to normal.

3. Once placed, kids need multiple sets of tubes: FALSE! As noted, ear tubes simply buy time for a child's immune system and eustachian tubes to mature. This happens at different rates for different kids. 4 out of 5 kids' ears clear up in the months after initial tube placement and don't have further problems. This means that 80% of kids who get tubes once won't need another set. The remaining 20% need another set to "buy more time" for the ears to mature. Some of these kids might also benefit from removal of their adenoids, and a blood test for allergies as well. A small percentage will need a 3rd set of tubes, and I often place a longer acting set of tubes called "T" tubes. These tubes are engineered to stay in for several years, and are easily removed in the office without anesthesia when they have served their purpose.

4. Tubes cause hearing loss: FALSE! A number of medical studies over the past 20 years have shown that ear tubes do not cause hearing loss, and on the contrary eliminate hearing loss caused by fluid behind the eardrum. Many toddlers and preschoolers with eustachian tube problems develop fluid-related hearing loss, and this often causes delay in speech and language development. Ear tubes usually normalize hearing and help young children to learn to talk when they are ready.

There are a few children who end up with permanent hearing loss, but it is usually due to persistent eustachian tube problems or severe recurrent or untreated ear infections. In these rare cases, it's actually the infections that cause damage to the eardrum or ear bones with resultant permanent hearing loss. Fortunately, these cases are rare, and as long as each ear infection is treated (whether by antibiotics or ear tubes), permanent hearing loss is avoidable.

If your child has frequent ear infections (3 or more in the past 6 months that required treatment with antibiotics) or fluid in one or both ears that has been present for 3 months or more, you should consult with your family doctor or an ENT about the possibility of ear tube placement. You can learn more about ear problems here and here.

Check out this YouTube video of the process of ear tube placement if you are curious.

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