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Drainage Tubes for Chronic Ear Infections?

Pediatrics Expert Advice from Henry Bernstein, M.D.

Q: During the last two winters, my son has had chronic ear infections. He is currently 19 months old. Once he gets the first one it's a chain reaction. Clear one up and it's gone only a few days, then back to medicine. People are really pushing tubes. I had tubes four times as a child, with no benefit. I have hearing loss and speech trouble. Not to mention having to wear earplugs for many years. I am very scared and concerned about giving tubes to my son. He LOVES the water, too. What is your opinion and do kids "outgrow" ear infections at about age two?

A: Winter, colds, ear infections, tubes, hearing, and speech -- very, very common concerns for parents and physicians alike. As with many things in medicine, there is often not a clear-cut or easy answer to the variety of issues you raise. Ear infections happen more often in children than adults, with a majority of all kids getting at least one ear infection in their first two years of life. There are several risk factors for having recurrent ear infections, such as being male, having a family history of the same problem, having your first ear infection at a very young age, not having been breast fed, attending daycare, and being exposed to household smoke.

So how does a child get an ear infection? The middle ear is congested and filled with fluid, particularly with colds or allergies. This fluid then can become infected with lots of inflammation and germs. The Eustachian tube that allows drainage of this fluid from the middle ear area does not function well during colds.

The length and position of the tube in younger kids also contributes to the poor drainage. As children get older, this Eustachian tube gets longer, wider, and becomes more vertical, which allows better drainage. Hence, some kids actually do seem to "outgrow" ear infections (or at least get fewer).

We often try to manage frequent ear infections medically (e.g., a small dose of an antibiotic each day during the winter to prevent infection) hoping to bide time until the child is older. However, hearing and speech are definitely linked and should be monitored very closely. If medical management fails, the surgical option of having tympanostomy tubes placed to permit better drainage should be explored to improve hearing.

You should be involved in the decision-making, but need to be fully informed. It is important that your child's doctors, who follow him over time and know him best, put all the pieces together and discuss all the options with you.

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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.


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