Ear Tubes Reduce Infections, Review Concludes

Once again, your baby is spiking a fever and tugging at his earlobe, obviously in pain. Your pediatrician confirms what you already knew: another middle ear infection. Only this go-around, instead of taking a “wait and see” approach or prescribing antibiotics, she suggests it might be time to turn to tubes.

Ear ventilation tubes reduce or eliminate ear infections for up to six months after insertion, according to a new review of studies, led by Dr. Stephen McDonald, an ear, nose and throat specialist at St Michael’s Hospital in Bristol, England.

In the United States, physicians perform anywhere from 500,000 to 2 million tube insertions each year on children with recurrent acute otitis media and chronic fluid.

McDonald does not make wide use of tubes in his own practice: “I tend to be conservative, as the major indication, otitis media with effusion — OME, or ‘glue ear’ — tends to be a relapsing, remitting condition, with only a minority of children having a sustained hearing loss.”

Some consumer health advocates and parents question whether the tubes are worth the risks of surgery.

“Most tubes in children are done under general anesthesia, although kids older than 8 years may tolerate local anesthesia,” said Kenny Chan, M.D., chief of pediatric otolaryngology at the Children’s Hospital in Denver. Risks of tube insertion include post-operative pain, ear drainage after infection and a small risk of eardrum perforation when the tube falls out, Chan said.

“Discharge for a day or two post-insertion is common,” McDonald said. “More rarely, discharge continues for longer, or occurs after an interval. In some cases this is an indication for topical treatment with antibiotic drops,” McDonald said, though oral antibiotics are sometimes used.

“The controversy has been around a long time for recurrent otitis media and putting tubes in,” said Stephen Berman, M.D. He is section head for general academic pediatrics at the University of Colorado medical school and the Children’s Hospital. “To decrease infections by one to two over a six-month period: is it worth it?” he asked.

A variety of bacteria and viruses can cause middle-ear infections, with pneumococcal pneumonia bacteria and influenza B virus the most common culprits, according to the researchers. Preventive antibiotics are one strategy for treatment, but with growing concerns about antibiotic- resistant germs, most doctors prescribe antibiotics only when infections actually arise, if at all.

Often, all parents have to do is watch and wait for the infection to clear. “In children ages two and older, people are moving away from antibiotics; it’s more of a wait-and-see interval,” Berman said. “If in 48 to 72 hours the child is still febrile, still in pain, we may use antibiotics.”

Physicians consider ear tubes when ear infections become a pattern. Recurring infections can cause mastoiditis, temporary hearing loss or even permanent hearing damage, according to the reviewers.