Let the Ear Tube Season Begin!

The start back of school, new daycare classmates, and the upcoming cold season are a ripe time for ear infections. The earliest middle ear drainage procedures were performed in the late 18th century as a treatment for eustachian tube failure. This involved cutting the eardrum with a small knife (called a myringotomy). It was not until the mid 20th century that tubes came into routine use to help keep these eardrum holes open for long periods of time.

Still today we don’t have a better treatment for eustachian tube dysfunction. The techniques occasionally change (usually driven by profitable medical device fads) but the principle of disrupting a normal eardrum to bypass an abnormal eustachian tube remains ENT dogma.

There is controversy about when to recommend ear tubes ("tympanostomy tubes") for patients suffering from ear infections. There is a concern from some that the procedure is over-utilized by doctors and that too many kids get ear tubes. There is also some uncertainty as to the actual diagnosis of ear infections or "fluid" behind the ear (many doctors may over-diagnose the condition). On the upside the procedure is very safe, practically painless when done under anesthesia, and can provide instant dramatic improvement in pain and hearing if done on the right patient.

The commonly accepted standards are that at least three infections in a 6 month period, or four in a 1 year period will warrant a set of tubes. Also fluid that persists in the ears will limit hearing, and this can result in speech delay for young children. The concern for speech delay from "chronic serous otitis media" is very real and is probably the most common justification for tube placement.

Between issues of questionable diagnosis, concern for overutilization, simplicity of procedure, controversial guidelines, and parental preference, the recommendation for tubes will often be based more on the preconceptions of the parents rather than best medical practice. This is particularly true at many "high volume" practices that wind up essentially being tube and tonsil factories recommending surgery to everyone that walks in the door.

If you are concerned about the frequency of ear infections, or their impact on your child’s hearing, it is important to have an open dialogue with your child’s doctor (usually not a midlevel provider) to understand the true rationale and expected benefits of tubes. If your doctor does not have the time or energy to weigh the pro’s and con’s of surgery with you, I encourage you to find one who will! We exist!