Ear infections are one of the most common reasons for illness office visits for kids, and many of the parents of the children afflicted with them are familiar with the placement of tiny tubes in one or both eardrums to prevent recurrent infection or persistent fluid. It should come as no surprise that this is the most common surgical procedure in young children, and one involving general anesthesia.
Parents who have dealt with the surgery or even its consideration will probably recall a lot of discussion with their pediatricians and ENT’s as to just when this should be done, the pro’s and con’s, and other considerations. They will probably also recall that the decision seemed to be a judgment call, which might often appeared arbitrary. And when it is an operation on your baby, who wants arbitrary? Some relatively objective assistance is on the way. Earlier this month the official journal of the AAO published a set of guidelines complied by a mixed group of doctors and others ” that helps physicians identify children most likely to benefit from tympanostomy tubes” and provide additional care recommendations.
A summary of the guidelines, taken from the Academy statement included the following recommendations below. In interpreting these, it is important to appreciate the definitional difference between acute otitis media (AOM), which can include inflammation of the ear drum, usually with significant redness and fullness or bulging due to a truly purulent buildup behind the drum, and otitis with effusion (OME) , which presents with fluid only. From the AAO:
1. Many children with a fluid build-up (otitis media with effusion, or OME) in the middle ear (behind the eardrum) get better on their own, especially when the fluid is present for less than three months.
2. Children with persistent OME for three months or longer should get an age-appropriate hearing test.
3. Tympanostomy tubes should be offered to children with hearing difficulties and OME in both ears for at least three months, because the fluid usually persists and inserting tubes will improve hearing and quality of life.
4. Tympanostomy tubes may be offered to children with OME, lasting at least three months in one or both ears, and symptoms that are likely attributable to OME–including: balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life.
5. Tympanostomy tubes should not be performed in children with recurrent (frequent) ear infections (AOM) who do not have middle-ear effusion (fluid behind the eardrum). In contrast, tubes should be offered when middle-ear effusion is present because the tubes will prevent most future AOM episodes and will allow episodes that do occur to be treated more safely, with ear drops instead of oral antibiotics
.6. Tympanostomy tubes may be offered to children who are at-risk for developmental difficulties when OME is present in one or both ears and is unlikely to resolve quickly. This includes children with permanent hearing loss, speech/language delays or disorders, autism-spectrum disorder, Down syndrome, craniofacial disorders, cleft palate, and/or developmental delay.
7. Ear infections that occur in children with tympanostomy tubes should be treated with topical antibiotic ear drops only, not with oral (systemic) antibiotics, since drops are more effective and have fewer side effects.
8. Children with tubes can usually swim or bathe without earplugs, headbands, or other precautions.
There will always be an element of clinical judgement, of course, but these fairly specific guidelines should be helpful for both families and their doctors.