Ear Tubes: To Tube or Not to Tube that is the Question?

I don't ever recall any one of my friends while growing up ever having an ear infection, much less having a doctor prescribe tympanosotomy ear tubes! Something has changed and kids today seem much more susceptible to ear infections.

So why the increase in ear infections?

According to the University of Maryland Medical Center, "The rise in ear infections has paralleled the increasing incidences of other upper and lower airway disorders such as Asthma, Allergies, and Sinusitis. For example, the same bacteria are often responsible for both ear infections and sinusitis. In one study, 38% of children with ear infections also had sinusitis, and other studies have reported that nearly half of children with Otitis Media have concurrent sinusitis. Data indicates that nearly a third of infants and toddlers with upper respiratory infections go on to develop acute Otitis Media. Researchers are looking for common risk factors, such as:

• Increase in Day Care Center Attendance. Although ear infections themselves are not contagious, the respiratory infections that precipitate them can pose a risk for children with close and frequent exposure to other children. Some experts believe that the increase in ear and other infections may be due to the higher attendance of very small children, including infants, in day care centers beginning in the 1970s. Research presented at a 2006 pediatric medicine meeting suggested that it may be wise to keep very young children (under 1 year old) out of day care to avoid exposure to the upper respiratory infections that can lead to ear infections.

• Increase in Allergies. Some experts believe that an increase in allergies is also partially responsible for the higher number of ear infections, which is unlikely to be related to day care attendance. Studies indicate that 40 - 50% of children over 3 years old who have chronic Otitis Media also have allergic rhinitis (hay fever). Allergies can cause inflammation in the airways, which may contribute to ear infections. Allergies are also associated with asthma and sinusitis. However, a causal relationship between allergies and ear infections has not been definitively established." Nor has it been determined if poor indoor air quality is linked to the increase in allergies.

• Breast-feeding, "rather than formula-feeding, is one important preventive measure. Studies show that breast-feeding for at least four months cuts the number of ear infections in half."

• Smoking and air quality. "Smoking is another factor that raises the risk of ear infections. Tobacco smoke can irritate the mucous membranes in the nasal passages, causing them to swell. This increases the likelihood of fluid getting trapped in the middle ear. Even fragrances, colognes, and air fresheners can irritate the mucous membranes.

• Genetic Factors. Children who have had previous ear infections are at greater risk as well as children with a family history of ear infections. Children born prematurely or with a low birth weight also are at greater risk. And, interestingly enough, if your child is male there is a higher risk of ear infections (boys tend to get more ear infections than girls) or if your child has a nasal speech (caused by large adenoids that block the Eustachian tube) they are also at risk.

• Nighttime Bottle. Taking a bottle to bed at nights.

• Pacifiers. Pacifiers can also increase the incidence of ear infections. It is not understood whether this is because pacifiers are not properly cleaned, or because the sucking motion causes bacteria to flow upward into the Eustachian tube."

• Food Allergies. Doctors have suggested that up to 1/3 of all cases of ear infections are due to dairy or milk allergies. Other foods may be suspect, but the connection between dairy and ear infections is one of the first places to start a food elimination program.

The most common ear infection and the one in question is Otitis Media. According to Dr. Greene.com, this is an "infection in the space behind the ear drum. Bacteria enter the middle ear through the Eustachian tube, a narrow channel that connects the inside of the ear to the back of the throat just above the soft palate.

The Eustachian tube is an intermittent drainage conduit to prevent the secretions that are normally made in the middle ear from building up and bursting the thin ear drum. Instead, they drain down the tube and are swallowed. Tiny hair cells in the tube propel this mucus blanket like a conveyer belt to carry bacteria down the drain. The Eustachian tube also functions to keep the air space in the middle ear at the same pressure as the air around us. In this way the eardrum can move freely allowing our hearing to be most effective.

When all is well, the Eustachian tube is collapsed most of the time in order to protect the middle ear from the many organisms that live in the nose and mouth. Only when you swallow does a tiny muscle open it briefly to equalize the pressures and drain the ear secretions. If any bacteria make it into the ear, the drainage mechanism, helped by the little hair cells, should flush it out.

Ear infections are the result of the Eustachian tube not performing its job. When the tube is partially blocked, fluid accumulates in the middle ear. Bacteria already there are trapped and begin to multiply, then air in the middle ear space escapes through the thin lining into the bloodstream, producing a partial vacuum. This sucks more bacteria from the nose and mouth into the ear. If the tiny hair cells are damaged (as by a cold virus), the mucus blanket can't help move the bacteria out."

Dr. Greene explains that people commonly believe that getting water in your baby's ears during swimming or bath time can cause ear infections in children, but this is not true. Ear infections happen when the Eustachian tube is blocked. Although a myriad of factors can lead to a blocked tube, getting water in your baby's ears won't. So, let your baby enjoy bath time and swimming!

If my child has an ear infections, are antibiotics necessary?

The normal protocol for treatment of Otitis Media is antibiotics. Until recently, all children with ear infections were given antibiotics.

According to the New York Department of Health, "If an antibiotic is prescribed, it will likely be AMOXICILLIN, unless the child is allergic to penicillin. Depending on the situation, the provider may decide that the child should take the antibiotic for five days instead of the usual 10 days. This should be the decision of the health caregiver. If the treatment doesn't work, more antibiotics may be needed.

New research suggests that many children with ear infections will get better without antibiotics, and with no ill effects. This is called the observation option. This option reduces the use of unnecessary antibiotics, and limits the child's exposure to the side effects of antibiotics. It also reduces the chance that "super bacteria" bacteria that cannot be killed by antibiotics will develop."

According to recent studies, only about one-third of children with acute Otitis Media actually need antibiotics. Most children get better on their own in two weeks without any treatment at all.

The pros and cons of tympanosotomy ear tubes:

Often times when a child experiences chronic ear infections or chronic fluid in the ear, he or she will be referred to the Otolaryngologist to place tympanosotomy tubes in the ear, a surgical procedure. Usually, doctors will recommend the surgery if the child has 3 episodes (ear infections) within 6 months or 4 episodes in 12 months. This is especially true if the antibiotic treatments are tried and have failed to resolve the issue. The reasoning here is that the child's recurring ear infections are due to fluid in the middle ear canal. This fluid is unable to drain down the Eustachian tube. If the fluid could drain, the bacteria would not be able to grow and cause an infection.

The issue at hand remains: to tube or not to tube…..let's identify the possible benefits and then review the possible risks or side effects.

According to Dr. Judith E. C. Lieu of St. Louis Children's Hospital, studies have shown that tympanosotomy ear tubes can improve the quality of life for children (and families) in the following ways:

• "Reduce the frequency (number in one year) of ear infections

• Reduce the severity of symptoms (ear pain, fussiness, poor sleep, hearing loss, etc) associated with ear infections

• Improve or cure the hearing loss that comes from chronic fluid in the middle ear

• Reduce caregiver anxiety about children who are often sick with ear infections

• Reduce how much antibiotic a child receives for ear infections"

• Even with tubes, children have an average of 1 to 2 ear infections per year. When ear infections occur, caregivers may see drainage from the ears, which can look like the drainage from the nose when someone has the common cold or sinus infection.

• Water exposure in the ears with tympanosotomy tubes can sometimes cause ear infections, particularly when the water is dirty or contaminated (such as with bathwater or lake/river/ocean water). Some type of earplug is usually recommended when you expect a child with tubes will be exposed to dirty water.

• Persistent holes in the eardrum may exist even after the tympanosotomy ear tubes have come out on their own, sometimes requiring more surgery to repair the eardrum.

• Minor degrees of ear drum scarring happen in almost one-third of children with tympanosotomy tubes. This usually does not result in any change in the way the eardrum functions."

Your best defense is to be as informed as possible. Getting to know what causes ear infections, understanding your child's type of ear and knowing the risks involved in surgery will help you make the best and most informed decision for your child.

http://www.umm.edu/patiented/articles/
what_causes_middle_ear_infections_children_000078_2.htm

http://www.drgreene.com/21_750.html

http://www.health.state.ny.us/nysdoh/antibiotic/4815.htm

http://www.blockcenter.com/ADD_ADHD/Ear_Respiritory_Infections.html

http://www.medicinenet.com/ear_tubes/page2.htm#1whatare

http://www.stlouischildrens.org/tabid/88/itemid/1796
/Ear-Tubes--Does-My-Child-Need-Them.aspx

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