Ear Tubes in Children May Be Over-Prescribed

Every year, about 500,000 children have ear tubes surgically implanted in their ear drum. The tubes reduce the number of ear infections kids get, as well as the pain that accompanies infections. But ear tubes are not for everyone. Experts estimate that as many as one-third of kids who get ear tubes don't need them.

Adrien Duteil, however, was a perfect candidate. At 2 years old, Adrien had the distinction of already suffering more than 11 ear infections. He had been to the doctor dozens of times, suffering fever, runny nose and pain. Adrien's father, Arnaud Duteil, says

"We were seeing that his mood was changing," says Arnaud Duteil, Adrien's father. "He was getting frustrated quickly, annoyed and doing things he would not normally do."

The ear is sensitive, and pain from an ear infection can be severe. UCLA pediatric ear nose and throat specialist Dr. Nina Shapiro describes it as a "sharp, stabbing pain."

The passageways inside kids' ears aren't fully developed until about age 12. For some, that means air doesn't circulate properly, and fluid can build up behind the ear drum. If that fluid becomes infected, the ear drum gets inflamed and swells, which is why it's so painful.

With Adrien, Arnaud Duteil says, "at some point, we were going to the pediatrician every other week. And every other week, he was getting antibiotics and we thought we could see him becoming resistant to the antibiotics because it was taking more and more time to clear. We were wondering if the medication had any effect at all. Adrien seemed to be constantly sick."

Bacteria can become resistant when antibiotics are used frequently.

"There's a 50-50 chance normal doses of antibiotics won't work, which is why tiny tubes implanted in the ear drum are an option," says Dr. Nina Shapiro. "They act as mature ventilation systems. So, once a tube is in the eardrum, it prevents fluid from building up. If there's no fluid that builds up behind the ear drum, then that fluid can't become infected."

Tubes decrease the number of infections by at least one infection, and maybe even several a year, according to experts. Shapiro says infections are reduced "significantly." And, with tubes, even if kids do get an infection, the ear drum swells less and the infection is far less painful.

But Shapiro cautions that tubes are recommended only for kids with chronic ear infections, which is defined as more than six infections in one year.

"Some children have what a parent considers a lot of infections," says Shapiro. "Maybe they've had three infections this year, which of course, is horrible. But remember, children get 10 to 12 colds a year, which is really about a cold a month. So, if they're getting a few ear infections, that's considered normal."

In addition, there's another group of kids who get ear tubes but don't need them. They don't have chronic, painful infections. Instead, they've been prescribed tubes because fluid frequently builds up in their ear drum, often after a cold. This fluid can muffle sound. In the past, doctors have worried that this temporary hearing loss might lead to speech and learning problems. But, in a recent study from the University of Pittsburgh, about 400 children were followed for 10 years. Researchers found that those who got ear tubes did no better on speech and language tests than those who didn't get ear tubes.

Dr. Steve Berman is a professor of pediatrics at the University of Colorado. He's also director of pediatrics at Children's Hospital in Denver and past president of the American Academy of Pediatrics.

"I think we can be totally reassured now that those children are not going to have bad effects from having that degree of mild or moderate hearing loss," he says. Berman adds that as many as one-third of ear tubes may be unnecessary – and the money can add up.

"Each of those surgeries probably costs between $3,500 and $5,000," Berman says. "So, we're potentially talking about a lot of money that could be saved by avoiding these unnecessary surgeries."

Instead of turning to surgery to boost speech development, Berman suggests that parents instead consider spending more time reading and talking with their children.

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