Does Your Child Really Need Ear Tubes?

New guidelines composed by the American Academy of Otolaryngology suggest that too many Ear Tube Surgeries are performed, some of them for the wrong reasons. The extensive research offers physicians guidance on which children benefit most from the ear tube surgery.

The new guidelines are aimed to provide more detail for the physicians and the parents on how to decide when ear tube surgery is needed, and how to care for the child after the tubes are put in. According to the research, the insertion of ear tubes is not always necessary. In common cases, “Wait & Watch” is a good strategy, since children usually heal from the ear infections on their own, and the fluid in the ear drains naturally over time.

Who needs ear tube surgery?

Ear tube surgery is the most common surgery done in the USA for children under the age of 15. Over 600 thousand surgeries are done annually, and statistics say that 1 in 15 children will get ear tubes by the age of 3.

Ear tube surgery is needed in cases where the middle ear is full of fluid, which does not drain naturally. In the middle ear there is a tube called Eustachian tube which is in charge of draining fluid from the ear and equalizing pressure. In young children, the Eustachian tube is immature and does not function well. Ear tubes are meant to solve this dysfunction.
In fact, if you open the Eustachian tube naturally, you can avoid the ear tube surgery!

What are ear tubes?

Ear tubes surgery is also known as Myringotomy. In this surgery, tiny rice grain size tubes are inserted in the ear drum to help the ear ventilate and drain excessive fluid from the ear. The tubes are inserted by a small incision in the ear drum, and stay there for a year or two.
Ear Tube Surgery is done under general anesthesia of 2-3 hours, and is considered a short and simple procedure.

Does my child need ear tubes?

The new guidelines provide better definitions of who needs ear tubes. The aim of the new guidelines is to lower the number of procedures done yearly, but also to give more details to those whose child needs ear tubes. The guidelines make a clear distinction between children whose ear is drained from fluid, and those with the persistent fluid buildup.
The guidelines state a few cases where the ear tubes are needed:

1. The child has recurrent ear infections, and the fluid in the ear does not drain even 3 months after the infection is healed.
2. The child suffers some hearing loss, which occurred after an ear infection (or a few of them). Other symptoms which suggest fluid is causing damage are poor balance (or loss of balance), difficulty listening in large groups or when the speaker is facing away from the child (a teacher facing the board in class), and if development delays related to hearing are diagnosed.
3. Children at-risk for development delays – this group includes Down Syndrome, children on the Autism spectrum, children with permanent hearing impairment and Cleft palate. If the child is at-risk and has recurrent ear infections – it is recommended to consider ear tubes.

Ear Tubes have provided significant benefits in all these cases, and research covered in the guidelines support it. The new report also breaks some myths about ear infections.

Myths and misconceptions of ear tube surgery caring for them

One big myth that the report wanted to break, and provide the parents with some relief, is the myth of “a child can’t swim with ear tubes”. Though it seems logical that the ear tubes will let the water get in the ear, the report states differently.
The ear tubes are so small (1/20th of an inch) that the water just can’t push in. For children who just go swimming in depth less than 6 feet, there is no reason to avoid swimming and no protection is required for the ear. For diving in more than 6 feet, ear protection should be used (consult with your ENT)
Another myth is that the ear tube surgery means another surgery to remove the ear tubes. The Ear tubes will fall by themselves, and the ear drum will heal naturally. This usually happens in 9-12 months from the insertion, but it can take up to 2 years until they fall out.
And a few other myths:

• Ear tubes do not scar the ear drum. Recurrent ear infections which stretch the ear drum is the cause of the scaring.
• Ear tubes efficiency is not harmed by being a kid – the child can run, play, swim and even fall.
• Ear tubes do not prevent ear infections. The tubes help the body heal, but not prevent the ear infection (though they are less common in children with ear tubes)

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