Tubes in the Ears (Otitis Media)

Otitis media is an infection involving the middle ear space, which is behind the eardrum. The middle ear contains the small bones known as the hammer, anvil and stirrup, and is normally filled with air, which enters through the Eustachian tube. The Eustachian tube does not function well in young children, because it is much shorter and more horizontal than it is in adults.

It may also swell shut as a result of a cold, allergy or exposure to tobacco smoke. Children who stay at day care centers have more frequent infections than do children who stay at home.

If air is not able to enter the middle ear through the Eustachian tube, then fluid may accumulate within the middle ear space. The fluid prevents movement of the eardrum, and causes a temporary hearing loss. This fluid may also become infected, resulting in fever, pain and irritability.

Antibiotic treatment speeds recovery and shortens the duration of the hearing loss. Pain and fever usually improve within a few days after starting properly selected antibiotics. The fluid may persist for several months following an infection. A follow-up examination is recommended to ensure that the fluid has resolved.

An alternative to antibiotic therapy is a procedure called bilateral myringotomy with tubes. Tubes are often recommended in children who have had several infections or have had persistent fluid for three months or more. Occasionally, tubes are placed in children with severe infections not responding to antibiotics. This procedure often immediately restores hearing and relieves pain. In most children, tubes prevent further infections and lessen the need for prolonged antibiotics.

On your initial office visit, your child will be evaluated by an ear, nose and throat specialist. We may perform a hearing test, or other diagnostic procedures. Please bring a list of current medicines and allergies, and a list of your child's infections during the past year. If we recommend surgery and you decide to proceed, we will take care of scheduling and help you with insurance preauthorization. Back to Top >>

Risks:

A certified nurse anesthetist will carefully monitor your child throughout the procedure. The risks of anesthesia are very small. You may discuss any concerns you have with the attending anesthesia physician prior to surgery. There is very little pain after the procedure. A few children will develop ear infections despite the placement of tubes. However, the tubes will allow the infected fluid to drain out of the ear. You will therefore be able to recognize the infection at home, and your child will be less likely to develop pain or fever. A permanent hole in the eardrum is quite rare. Occasionally it is necessary to repair the hole after the tube falls out. It is far more common for children to return for a second set of tubes before they out-grow their tendency to develop the ear infec-tions. Back to Top >>

Alternatives:

Antibiotics are usually effective and safe for acute infections. Occasionally, daily antibiotic treatment through the cold and flu season has been effective in preventing acute otitis media. However, antibiotics become less effective with frequent use, because the bacteria develop re-sistance to the medication. Children may also accumulate allergies or other side effects to antibiotics, thereby limiting the choices of medication available in the future. Antibiotics rarely relieve fluid that has been present for longer than three months. Back to Top >>

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