Easing the pain: recurrent ear infections require close attention
From pain and fever to potential hearing loss and speech delays, fluid trapped in the middle ear space behind the eardrum can cause a variety of problems.
So what's the best way to treat it? If the fluid isn't infected, it probably won't respond to antibiotics. Most episodes of uninfected fluid (serous otitis media) will clear spontaneously within a few weeks, so observation is the best initial treatment. If the fluid becomes infected, the child will typically experience pain, fever, difficulty sleeping and behavioral changes. The options are to try acetaminophen for pain for 24 to 48 hours and see if the body's immune system can take care of things, or to move right to antibiotics, which should help improve symptoms within a day or two.
For most children, these interventions work, but for others, they're not enough. Uninfected fluid lingers for several months, causing a hearing loss and increasing the risk of permanent speech delay. Antibiotics beat back infection, but it returns the next month and the one after that.
At that point, says Children's Hospital Boston otolaryngologist David Roberson, MD, it's probably time for ear tubes. "If parents are okay going through the ear infection-antibiotics cycle and waiting to see if the child grows out of the problem, then placement of ear tubes is an elective procedure," he says. "But if there is any speech delay, tubes really need to be placed so the delay doesn't become permanent."
Ear tubes come in a variety of sizes, shapes and materials that allow surgeons to best fit the tube to the child, but they're all designed to create an artificial hole in the eardrum to ventilate the middle ear.
Tubes are placed during a fairly straightforward surgical procedure that typically takes about 10 minutes for both ears. "There are several advantages to getting tubes placed," says Dr. Roberson. "It has a very high success rate, improves hearing and usually leads to fewer infections down the road."
The one drawback, he points out, is that the procedure requires general anesthesia, since any movement by the child could cause permanent damage to the eardrum.
Once placed, they are usually successful in significantly reducing ear infections—or eliminating them altogether. Most children will get one or two infections a year, and the infected pus typically drains on its own, thanks to the opening created by the tubes.
Ear tubes require relatively little follow-up as well. Children who get them return to their otolaryngologist's office a month after the procedure, then every six months after that, and the tubes usually fall out on their own within nine to 12 months after placement. By that point, most children have outgrown their ear problems and don't require additional sets of tubes. But 25 percent of children don't outgrow their ear problems and need a second set placed.
Such was the case for 3-year-old Kevin Coupe. He got his first ear infection when he was only 9 weeks old, and went through two-week cycles on and off antibiotics for three months before having his first set of tubes placed. "The mild hearing loss he experienced was corrected by them, and he didn't have any speech delays," says Kevin's mother, Heidi. "He did get fewer infections, which were easier to treat once the tubes were in. But he still got them, so he got a second set of tubes the following year."
According to Dr. Roberson, if multiple sets of tubes don't work, then the source of the infections may be the adenoids, and removing them has been shown to reduce ear infections. Since adenoidectomy requires a longer surgery and several days for recovery, it is usually reserved for children getting their second set of tubes.