Which Kids Need Ear Tubes?

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Ear Infection

As millions of parents can testify, young children are prone to ear infections. Children are more susceptible to getting these infections because of the shape of the head and the position of the Eustachian tube, which drains fluid from the middle ear and connects the middle ear space behind the eardrum to the outside world.

In children the Eustachian tube is oriented more horizontally. As their head grows, it becomes more vertically oriented, as in adults. This usually occurs by the time a child is six or seven years old.

Debara Tucci, M.D., pediatric otologist (ear surgeon) in the Division of Otolaryngology, Head & Neck Surgery at Duke University Medical Center, explained what causes ear infections and how they typically affect children.

"The infections we worry most about are the bacterial ones," said Tucci. "Those are the most virulent. Bacterial infections occur when the bacteria get into the middle ear space, usually because it's obstructed in some way. The bacteria build up and can create pressure behind the eardrum, and the pain of the typical ear infection, which is called acute otitis media (AOM), comes because the eardrum is very sensitive to any movement.

"When the eardrum bulges out and there's also an inflammatory reaction from the bacteria in the middle ear, all of this can create a great deal of pain," she continued. "The pain is usually worse at night, when the child is lying down. When the child is upright, it takes some of the pressure off the eardrum. There is evidence that the hearing loss associated with ear infections can cause delays in speech and language development in some children."

Tucci said the standard first course of treatment for AOM is antibiotics. Although most infections will clear up on their own within a couple of days, an antibiotic such as amoxicillin usually helps speed up the process.

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"If that's not effective, usually the pediatrician would go on to a second-line antibiotic, which would be stronger and more effective against a larger array of bacteria," she said. "But that treatment may have more side effects, such as gastrointestinal effects. So the treatment of pediatric ear infections in pediatric practices is usually a two-tiered approach."

If the problem persists, tiny plastic drainage tubes can be surgically placed in the ear to help remove fluid and prevent further infections.

While some parents may want tubes placed at the first sign of infection, Tucci said that a wait-and-see approach is usually preferable. She says there is typically no need for tubes unless the infection becomes chronic and painful.

"If a child either has repeated ear infections, up to five or six a year, or if they have an effusion of fluid in the middle ear space following an ear infection that's associated with hearing loss, and that situation has lasted for three months, that's when I would certainly counsel the parents about the advisability of tube placement," she said.

"At that point, we are concerned about hearing loss, which is a big problem for children who are developing speech and language. Tubes have the benefit of reducing the number of ear infections, aerating the middle ear space, allowing the fluid to drain out and air to come in, and allowing the child to hear normally."

Tube placement is a common and safe procedure, with more than half a million ear-tube surgeries performed annually in the United States, Tucci said.

"I would say that about 95 percent of children who have tubes placed do extremely well," adds Tucci.

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