Nowadays it seems a very common treatment to put tubes in children's ears. I am taken aback by the idea of perforating the ear drums to do this. Perhaps this is just a fashion, and not really necessary. I would like to read some comments on the usefulness, and drawbacks, of putting tubes in the ears of small children.
Thank you very much.
Reply -----------------------------------
There has been a great deal published in the press in the last 1-2 years regarding the controversies surrounding the placement of tubes in childrens' ears, a procedure known as tympanostomy and tube insertion.
It is important to keep in mind some historical perspective concerning ear disease in children over the last several decades. Prior to the introduction of antibiotics around WW II, infections of the ears in children were not uncommonly complicated and complications were potentially fatal. Surgical treatment of ear infections was the most common form of medical intervention. After antibiotics were developed, the frequency of life-threatening complications of ear disease was dramatically reduced. Still, despite antibiotics, less severe complications of ear disease still occurred in children due to chronic fluid accumulation behind the tympanic membranes caused by eustachian tube dysfunction. Prior to the introduction of tympanostomy tubes in the 50's and 60's, many of these children with chronic ear fluid developed conditions that required significant surgical procedures such as mastoidectomy or tympanoplasty. However, since the introduction of tubes, the need for such extensive surgical procedures in children has been dramatically reduced.
The purpose of typanostomy tube insertion is to not only remove the fluid in the middle ear, but also to maintain pressure equalization within the middle ear relative to the ambient air pressure over a prolonged period of time so as to allow the restoration to a normal middle ear environment. Simple perforation and drainage of the fluid without the insertion of tubes (a procedure known as myringotomy) is generally insufficient in correcting chronic fluid problems since the perforations will frequently close within 1-2 days spontaneously which does not allow an adequate period of time for resolution of the condition.
The tubes most commonly used will remain in the ear drum on average for 6 months to a year before extruding on their own, followed by healing of the ear drum. Much has been written about scarring of the ear drum following tube insertion. The fact is that such scarring almost never causes morbidity of any degree. In other words, while scarring of the ear drum may be seen, it is rare for such scarring to be associated with hearing problems of even mild degree. It is also a fact that the same type of scarring (known as myringosclerosis) can occur in the absence of any surgery or trauma to the ear drum and can be related simply to previous ear infections.
All of that said, it is nevertheless important to note that there are well defined criteria for the placement of tympanostomy tubes in children and these criteria have been met with widespread agreement amongst pediatricians, family practicioners, and ear nose throat specialists. The most common indication for tubes in children is the persistence of fluid behind the ear drums that has been present in excess of 3 months. A complete description of the commonly accepted criteria for pediatric ear tube insertion can be found at the National Institue of Health web page.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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