Kids Love Dr. Barton

To Tube Or Not To Tube?

by Dr. Douglas Barton, M.D., Pediatrician 06/24/2009

Although most of our readers have heard of ear tubes, they might not really know what their pediatrician is talking about when they recommend having tubes placed.  

To start with, ear infections generally occur when there is trouble equalizing the air pressure behind the ear drum. Ordinarily, this is accomplished as air passes freely through the eustachian tube which extends from the middle ear to the back of the throat. If the eustachian tube is functioning normally, air pressure in the middle ear is the same as air pressure outside the ear. If it is partially or completely blocked (because of allergies, a cold, small size, etc.), negative pressure builds up behind the ear drum. This pulls fluid into the middle ear space. Now we have a perfect environment for bacteria: dark, warm, fluid-filled and poor blood flow. Bacteria from the upper respiratory tract work their way into the middle ear and set up camp, multiplying into the billions. Now we have a full-blown ear infection.

Studies have shown that in children older than two, ear infections heal on their own within a couple of weeks in 90+ percent of cases. It is likely that they go away faster when antibiotics are given, though some experts dispute this. In younger children, there appears to be a higher risk of complications, so antibiotics are a prudent treatment… when they work. Unfortunately, as antibiotics have become more pervasive in our environment, bacteria have become increasingly resistant to them, limiting the efficacy of antibiotics in any given patient. There is no way (short of sticking a needle through the ear drum of a screaming child) to know for sure which bacteria is in the ear and which antibiotic will treat it.

In some children, no matter how many different antibiotics we use, the ear infection just won’t clear up. There is antibiotic resistance, or the eustachian tube is completely blocked, or the sinuses are completely full of mucous, or there are allergies interfering. In these cases, it can be helpful to provide an alternative to the eustachian tube, ie. a tube!

Myringotomy tubes (tubes, ear tubes, etc.), are small tubes of either plastic or metal that look a lot like a bobbin on a sewing machine. They are inserted into the ear drum to create an alternative method of ventilating the middle ear space. They have an average life span of about nine months if they are short-term and two or three years for the longer term tubes. They will often reduce the frequency of ear infections from six or more a year to only one or two a year. They rarely create problems for children who have them and they generally need no special care. They do require general anesthesia to place. This is probably the biggest reason not to just rush out and place tubes in every child. Every anesthesia event has a small chance of complications. If the frequency and severity of ear infections are bad enough, however, this is a risk that may be justified.

Ear tubes aren’t for everyone, but if your child has many ear infections in a year, there may be a place for them in your child’s future. As always, consult your pediatrician for further information.




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