Ear Tubes to the Rescue! Five Indications for Ear Tube Placement
Ear tubes are tiny, hollow cylinders, often made of plastic or metal, that are surgically placed in the eardrum.
This tube creates a hole that allows air to get into the middle ear and stops the collection of fluid behind the ear drum.
I have already shared valuable information addressing ear infection myths, important ear infection facts, tips to prevent ear infections and 4 of the big, scary complications of ear infections!
But, I continue to be faced with ongoing ear infection questions.
So, I apologize to those of you who have children who do not suffer from recurrent ear infections. This post is for the families who seek additional information about treatments for unrelenting ear infections.First I need to clear up an important piece of information. “Ear tubes” is the most common term used to describe the drainage tubes inserted into the ear drum. However, there are several other names you might also hear, and they all mean the same thing! Some of the other names include:
- Ventilation Tubes (because the tubes allow ventilation (air) into the middle ear)
- Pressure Equalizing Tubes (because the tubes work like the eustachian tube to make the pressure in the room the same as it is behind the ear drum)
- Myringotomy Tubes (because the incision made in the ear drum is called a myringotomy)
- Tympanostomy Tubes (because tympanostomy describes the process of placing a tube in the eardrum to provide a longstanding drainage site)
- Tubes (because…duh!)
Regardless of the name used, the meaning is the same. Shakespeare said it best when he coined the phrase for Romeo and Juliet.
“What’s in a name? That which we call a rose. By any other name would smell as sweet.”
Regardless of what name is used, ear tubes temporarily bypass the eustachian tube and allow the middle ear to be filled with air instead of fluid.
Many different ear tubes exist. The color of the tube has no significance on the tube function. Designers create lots of new tubes with fancy features such as antibiotics made into the plastic, a filter in the center of the tube and slowly dissolving ear tubes. These gimmicks do not significantly change the end result of the ear tubes. The tubes simply provide drainage.All tubes are designed to be a short term solution. The tubes fall out on their own or need to be removed. They typically last from 6 months to several years, depending upon which tube is used. In my practice, 80% of patients under age 3 outgrow their problems, and I don’t see them again after tubes are gone.The other 20%… well they fill my practice, and we become besties! These children usually have some other problem (in the nose) which continues to impact the eustachian tube.
The nose is the key to the ear!
The above statement is a special Dr. Momma phrase! I say this every single day to my patients, so feel free to use it as needed! The basic meaning is that you must control symptoms in the nose if you want long-term control over ear infections.Young babies seem to have colds all the time. A recent article in the December 2016 issue of the Pediatric Infectious Disease Journal described what I see in my patients. Toddlers under age two commonly had cold symptoms for 44 days; however, some kids had symptoms for 100 days each year!This huge number of viral infections explains why that drippy nose frequently causes ear infections in young kids. However, these large numbers do not continue for your 3, 4 and 5-year-old kids. Something else is probably happening. These are my long-term patients!Children undergo ear tube surgery for a variety of reasons. One mom writes about her experience with all four children needing tubes. Usually parents and their pediatrician agree that the child has been seen and treated for too many infections.A consultation to the Ear, Nose and Throat (ENT) physician is then made. Every patient referred to ENT does NOT need tubes. An accurate history provides the most valuable information. Please do not forget the lessons learned about what is needed during a consultation with a physician specialist!Generally speaking, the number of ear infections or length of time that ear fluid stays behind the ear drum are the two main indications for ear tube placement.But….medicine is not an exact science! Your child may have these indications and end up not needing tubes or your child may not be as severe as the indications listed, but still would benefit from the tubes.
5 Common Indications for ear tube placement in children
1. Too many ear infections in a specific period of time
Roughly, 3 ear infections in 6 months or 4 in 12 months meets the basic criteria. Usually, pediatricians continue to treat them beyond these numbers in hopes of finding a way to control the recurrences.
2. Ear fluid remains behind the ear drum too long
Typically, ear fluid that fails to drain for 3 consecutive months meets the basic criteria. However, other factors are considered and may allow for delaying surgery. An assessment of speech, language and learning can add valuable information.
3. Antibiotic allergies and intolerances
When children have multiple antibiotic allergies, it is wise to avoid the repeated use of these medications because you do not want a resistance to develop to the few antibiotics the child can take. Likewise, debilitating diarrhea or colon infections may be better controlled when antibiotics are no longer needed.
4. Febrile seizures with each infection.
Some children routinely develop high fevers with ear infections which can trigger a seizure. Ear tubes often serve as a means to avoid the recurrent infections and fevers.
5. Severe Complications from trapped infection
These are the rare complications which require urgent ear tube insertion. If the infection become trapped in the bone surrounding the middle ear, a risk for meningitis, brain abscess or permanent hearing loss may result. Immediate surgical drainage to relieve the pressure is indicated.This blog has been written to address the common question: Should my child get ear tubes. The answer is not simple but hopefully this post serves as a guide. Additional blogs will be forthcoming to address ear tube myths, important facts about ear tubes and of course, complications of ear tubes!
