July 9, 2010
Dear Mayo Clinic:
My 18-month-old has had six ear infections in the last year. Is it time for ear tubes?
Middle ear (between the eardrum and the inner ear) infections are common in young children, and most of these infections are relatively easy to treat. But when a child has more than four ear infections in six months or, as in your child's case, six infections in a year, ear tubes may be the right choice.
Middle ear infections (otitis media) usually start with a viral infection, such as a cold. The middle ear lining becomes swollen from the viral infection, and fluid builds up behind the eardrum. Ear infections can also be associated with blockage or swelling in the narrow passageway that connects the middle ear to the nose (eustachian tube). If fluid gets trapped in the middle ear when the eustachian tubes become blocked during a cold, infection can result.
Children's eustachian tubes are in a more horizontal position and are narrower and shorter than those of adults, which is thought to make children more likely to develop ear infections. Middle ear infections are among the most common illnesses of early childhood, with three out of four children having at least one such infection by age 3.
When a child doesn't respond to treatment for ear infections, or when a child has one ear infection after another despite treatment, ear tube placement has been shown to decrease the number of infections.
Ear tubes (also called grommets, tympanostomy tubes and ventilation tubes) are tiny, usually plastic (Silastic), cylinders surgically inserted into the eardrum. The tubes provide ventilation to the middle ear, allowing fluid to drain and equalizing the pressure between the middle ear and outer ear. This helps prevent the fluid buildup that can be a breeding ground for middle ear infections.
The procedure to place ear tubes is fairly simple. It's done under general anesthesia, so your child will be asleep. The doctor will first clean out the ear and examine the eardrum to ensure it hasn't been damaged. Then the doctor will make an incision in the eardrum, remove any fluid, and insert the tube into the hole in the eardrum. The entire procedure usually takes about 10 to 15 minutes. Placement of ear tubes is typically done as an outpatient procedure, so your child should be able to go home the same day.
Usually, ear tubes stay in the eardrum for six to 18 months, and then fall out on their own as the eardrum heals. In about 5 to 10 percent of cases, a tube doesn't come out of the eardrum and must be surgically removed. In some cases, the ear tube falls out too soon and another needs to be put in. Depending on your doctor's recommendations, after the tubes are in place you may need to take precautions, such as using special earplugs to protect your child's ears and tubes when he or she is swimming or bathing.
For most children, ear tube placement results in decreased ear infections. Even with ear tubes, though, your child may still get an occasional ear infection. Additional benefits of ear tubes may include better hearing, improved speech and better sleep for your child.
It sounds like your child could be a good candidate for ear tubes. I'd encourage you to talk to your child's doctor about it. He or she can help you decide if tubes are right in this situation.
— Laura Orvidas, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.