New Guidelines for Ear Tubes
Wednesday, July 17, 2013
Ear tubes drain the fluid from the middle ear and dramatically reduce ear infections.According to the American Academy of Otolaryngology – Head and Neck Surgery
, ear tubes are most often recommended when a child experiences repeated middle ear infections or acute otitis media.These ear tubes, shaped like tiny cylinders, are precisely placed by the surgeon through the ear drum in order to drain the middle ear fluid and allow air to return into the middle ear, which is the normal way that ears work best.
Ear tubes are either placed for short-term or long-term use during an outpatient surgical procedure, but recent research shows ear tubes are not always be best.New Guidelines:
- Emphasize testing children with tympanogram and audiogram and rely more on perceived parental hearing loss to help identify children who should and shouldn’t get ear tubes
- Children with re-occurring ear infections can either undergo ear tubes or at a minimum should be monitored and brought back after four weeks to make sure there is recurrent infection or fluid
- If the child experiences hearing difficulties from fluid buildup in both ears for at least three months, ear tubes should be recommended and offered
- The previous recommendations to use ear plugs for children, who have ear tubes and are exposed to water with swimming or bathing, are no longer essential for children. Ear plugs can be expensive and a major inconvenience, plus they don’t reliably prevent infections
- Work closely with your child’s otolaryngologist (ear, nose, and throat surgeon) and pediatrician to understand the benefits of ear tubes before insertion
- “Watchful waiting” can result in delayed diagnosis of hearing loss, and is generally not recommended for children with pre-existing developmental delays – sensory hearing loss, autism-spectrum disorder, Down syndrome, and cleft palate
The American Academy of Pediatrics (AAP) recently revised the treatment plan for acute otitis media
(AOM), or middle ear infections. AOM is the most common bacterial illness in children. These guidelines outline importance of ear exam for appropriate diagnosis and judicious use of antibiotic treatment, as well as the importance of pain management.
“Our Ear, Nose, and Throat physicians at Children’s National
have relied on tighter criteria for placement of ear tubes prior to the newly published AAO guidelines,” said Children’s National Medical Center’s Brian Reilly, MD, a clinical researcher with specialized interests in hearing loss, cochlear implants, and otitis media.
“Most children don’t usually get to us unless they have had four to five infections in six to twelve months,” said Dr. Reilly. “We are very cautious not to rush surgery and work closely with pediatricians to select appropriate surgical candidates.” With new healthcare oversight and concern about containing healthcare costs, there has been an emphasis of practice evidence-based medicine. This means that physicians look closely to clinical trials to understand what makes sense and what does not before insertion occurs.Additional information:
About the Expert
Brian Reilly, MD, is Co-Director of the Cochlear Implant Program at Children’s National Health System. Dr. Reilly is an active clinical researcher with specialized interests in hearing loss, cochlear implants, otitis media, obstructive sleep apnea, and chronic tonsillitis.