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Ear Infections and Ear Tubes

Ear Infections

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Updated October 29, 2007

Updated October 29, 2007
Fortunately, most kids only get a few ear infections (otitis media) a year. It can be frustrating when they keep getting ear infections over and over again though.

Are they going to damage your child's hearing or delay their talking?

How many ear infections are too many?

When do you need to get ear tubes?

Indications for Ear Tubes

Ear tube or tympanostomy tube placement is the second most common surgery in children in the United States.

As far as an absolute number of ear infections, many experts would consider tubes for a child who has had three ear infections in six months or four ear infections in 12 months. Other experts use much more general guidelines and would place tubes when 'bouts of recurrent infection are frequent and occurring close together.'

Having fluid in their ears (otitis media with effusion) for more than three months and hearing loss is another reason children get tubes.

In addition to the number of ear infections a child has or how long they have fluid in their ears, a few other things that might influence you to get tubes early. These include having risk factors that make it likely that your child will continue to get a lot of ear infections in the future, including being a boy who is under 2 years old and who attends daycare, especially if getting a lot of ear infections runs in the family (genetic factors).

The 'type' of ear infections your child gets might also influence your decision to get tubes. If your child's ear infections are very painful, take more than a few days to get over, or they take multiple rounds of antibiotics to clear, then you might want to get tubes earlier than if your child's ear infections were not painful or quickly cleared up.

The time of year might also influence your decision about tubes. Even if your child has recently had a lot of ear infections, if it is April or May, you wouldn't expect her to continue to get sick as much throughout the rest of the Spring and Summer. In this case, you might wait a little longer than you might if your child had already gotten a lot of ear infections going into the Winter, when she would probably keep getting sick all of the time during cold and flu season.

Keep in mind that the decision on the when to get tubes is not as critical as most parents believe. In fact, one study, Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years, showed that 'in children younger than 3 years who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 3 years.'

So the timing of when to get ear tubes is not always as clear cut as you might think...

What You Need To Know

  • If you think your child has had too many ear infections, then ask your Pediatrician for a referral to a Pediatric ENT specialist to discuss if ear tubes would be appropriate.

  • On the other hand, if your Pediatrician recommends tubes but you are hesitant to have surgery, then ask if it would be appropriate to wait a little longer.

  • If your child is diagnosed with an ear infection, is put on antibiotics and is still having pain and fever a week later, that technically still counts as the same ear infection. And keep in mind that they can then have fluid in their ears for 2 to 3 months, which is often misdiagnosed as an ear infection. If you go back for a recheck and your child has no symptoms at all, but your are told he has an ear infection, you might get a second opinion from a Pediatric ENT specialist to see if it is just fluid.

  • Although some children have complications after getting tubes, such as blockage, drainage (otorrhea), granulomas, cholesteatomas, tympanic membrane perforation, and having the tubes fall out early, numerous studies have shown improved quality of life outcomes for children after getting tubes.

  • Take some steps to control the things that put kids at risk for ear infections, such as breast feeding as long as possible, and not exposing them to second hand smoke, letting them sleep with a pacifier, or letting them lay down while drinking a bottle.



Sources:

Modern management of acute otitis media. Weber SM - Pediatr Clin North Am - 01-APR-2003; 50(2): 399-411.

Common topics in pediatric otolaryngology. Pizzuto MP - Pediatr Clin North Am - 01-AUG-1998; 45(4): 973-91.

Tympanostomy tubes: types, indications, techniques, and complications. Morris MS - Otolaryngol Clin North Am - 01-JUN-1999; 32(3): 385-90.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Colborn DK, Bernard BS, et al. N Engl J Med 2001;344:1179-87.

Quality-of-life outcomes after surgical intervention for otitis media. Richards M - Arch Otolaryngol Head Neck Surg - 01-JUL-2002; 128(7): 776-82.

Impact of tympanostomy tubes on child quality of life. Rosenfeld RM - Arch Otolaryngol Head Neck Surg - 01-MAY-2000; 126(5): 585-92.

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