Is It Time for Tubes?
Understanding and Evaluating the Ear Infection that Won’t Let Up
You wake up at 2 a.m. on a weeknight to the sound of your 18-month-old moaning. After a few minutes of comforting, you notice him tugging on his ear.
“Not again,” you think to yourself. This would be his third ear infection in three months, and you are beginning to wonder if this is chronic or if there is a better solution than the usual antibiotic.
Middle ear infections are a common problem in young children, 6 months to 2 years old, and may be seen in some children into their teenage years. They result when the eustachian tube — a tube in the ear that balances air pressure — doesn’t open. As a result, fluid backs up into the middle ear. The fluid may get infected by bacteria tracking up the eustachian tube from the back of the nose.
“Chronic middle ear effusion with recurrent infection is most common,” says
Robert Sprecher, MD, pediatric otolaryngologist at Rainbow Babies & Children’s Hospital. “Effusion means fluid is temporarily sitting in the middle ear. A chronic infection that doesn’t go away is actually less common.”
Unfortunately, there is not much a parent can do to prevent these types of ear infections, aside from not smoking around the child or around the house.
The infections are more common during cold and flu season and in children who attend day care facilities. And, there is a minor hereditary component of middle ear infections. Infrequent infections are commonly treated with antibiotics.
“Middle ear infections are considered chronic when a child has had either more than four infections in six months, more than six infections in a year or fluid continuously for more than three months,” says Dr. Sprecher. “Children older than age 3 to 4 who keep fluid in their ears may be prescribed a nasal steroid spray to use for four to six weeks in an effort to eliminate the fluid. If that fails, then ear tubes would be necessary. The spray is usually not successful in children younger than 3.”
If it is decided that your child needs tubes, you do not need to worry as it is a relatively simple procedure. Parents can expect that their child will undergo about five minutes of general anesthesia, without an IV.
The surgical team will make a small cut in the eardrum, extract the fluid, put in the ear tube and repeat this process in the other ear.“Often, the child is up and running around 30 minutes after surgery like nothing happened,” adds Dr. Sprecher.
A child with tubes will not need to alter his daily living. It’s okay if clean water gets in his or her ears. Chlorinated pool water, tap water and even ocean water are also okay, but doctors prefer that the child does not lie down in the bathtub or swim in a lake.
Tubes generally stay in for one to two years and fall out on their own. They may, however, last longer and that is okay. Once a child gets to be 6 or 7 years old, then he or she probably doesn’t need the tubes anymore and they can be removed.
Only about 20 percent of children will require a second set of tubes, if they get back into a cycle of recurrent fluid and infection once the first set falls out. At that stage, the doctor also may recommend an adenoidectomy to surgically remove enlarged or infected adenoids, which may be contributing to the infections by interfering with ear pressure or fluid movement.