My son had 5 ear infections between 6 mos and 9 mos (or was it one that never went away??? First found on well-check, others present on re-checks). We saw an ENT who recommended bilateral tube placement. With the doctors ok, we took our son off all antibiotics and scheduled recheck with ENT 8 weeks later. During those 8 weeks, our son had no symptoms of ear infections. ( He also had no symptoms with earlier infections.) Upon recheck, our son was found to not be hearing below 40-45 decibels. Tonsils were enlarged and x-ray showed enlarged adenoids. The doctor recommended tonsils and adenoids be removed and tubes placed. My son just turned one. He appears happy and healthy. He talks alot and has learned new words recently. I am very concerned about the long term effects of removing these glands. Might these glands get smaller and not pose a problem as he gets older? If we choose to forego the surgery, is the biggest risk the hearing loss and possible language delays? Is there an alternative to this surgery? He seems so young for such and extensive intervention. Any comments and additional information would be greatly appreciated.
Reply: -------------------------
I would most certainly agree with you that this would be considered extensive and aggressive intervention for the treatment of ear infections in a 12 month old. The only instance in which I might remotely consider T&A appropriate for a 12 month old would be in the management of obstructive sleep apnea due to markedly enlarged tonsils and adenoids. Obstructive sleep apnea would be heralded by loud heroic snoring during sleep accompanied by very irregular breathing patterns including intermittent cessation of breathing (apnea). In a 12 month old with tonsil and adenoid enlargement sufficient to cause the serious condition of sleep apnea, one might also see some difficulty with swallowing and there would likely be an obvious speech characteristic known as hyponasal speech - as when one tries to talk with their nose pinched tightly.
You should also know that the scientific literature does not support surgical removal of the tonsils to treat chronic ear disease - tonsils may be removed in a child with ear problems to treat concurrent tonsil problems such as recurring strep throat or obstructive sleep apnea, but tonsil removal has never been shown to help in the management of recurrent ear infections in young children.
There is support in the scientific literature for adenoid removal in certain children who suffer from recurrent ear infections which fail to respond to medicine and allergy interventions. However, research has shown that typically only children over 4 years of age who have chronic ear disease will benefit from adenoidectomy. Many otolaryngologists, including myself, feel anecdotally that adenoidectomy is also useful in a younger child between 2 and 4 years of age who has had an extensive history of ear problems that has recurred despite having already had one set of tympanostomy tubes.
If your child of 12 months has had 5 recurrent acute infections with clearance of infection between episodes, I would not advise surgery of any kind without a trial of prophylactic antibiotic therapy. If breakthrough infection occurs while on preventative antibiotics, then tube insertion could be considered.
On the other hand, if the problem has been (as you have suggested) one continuous ear problem -chronic otitis media with effusion, and particularly if hearing loss is present, then if the problem persists beyond 3 months tube insertion alone would be highly recommended. At this age, no other surgical procedure would be indicated in my opinion for the ear problem.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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