As a surgeon, this is one of my least favorite questions. I hear it most often when a family comes to see me re possible ear tubes. Many families will be referred to see me when their child has had multiple ear infections requiring antibiotics, or if there has been persistent fluid behind the eardrums for months. The child may be frequently symptomatic with ear infections, or there may have been concerns about hearing loss. After a while, it may seem that these issues are continuous, and many families would love to know if there are any other options available.
Let’s consider the reasons behind the referral. Pediatricians will frequently refer children if there have been around three to four infections per six months, or five to six infections per 12 months. If the eardrum appears acutely infected, then your primary care physician (PCP) will prescribe oral antibiotics. Your physician may also refer your child if there has been persistent fluid behind the eardrum. It is very common to have fluid behind the eardrum after ear infections, and even after simple (uncomplicated) viral upper respiratory infections. The body can typically reabsorb this without difficulty. Sometimes, though, fluid may persist. If it’s present for less than three months, then your PCP may refer for further evaluation (and possible tubes).
Should I Consider Ear Tubes?
Let’s think about recurrent ear infections. Most infections occur along with viral upper respiratory infections. Infections are more frequent during cough & cold season. But they can occur at any time of the year. If your child is notably symptomatic with each acute ear infection (fever, fussiness, poor sleep, altered appetite), and this is what prompts you to see your PCP repeatedly, then tubes may be of benefit. If on the other hand the ear infection was diagnosed incidentally, (i.e., during a well-child exam) and your child was minimally symptomatic, then recurrent ear infections are typically less concerning to the family. Similarly, if there has been notable muffled hearing with persistent fluid behind the eardrums for three months, then this may also prompt doing surgery.
There are a few key populations that could benefit from tubes earlier on, especially those that have concerns for speech, hearing or developmental delays (such as those with Down’s syndrome or cleft palate). If your child falls into this category, then our conversation may lean towards tubes. It is very likely that we (my medical partners and I) would advocate for earlier placement of tubes. We want to give your child every tool for possible success.
On the other hand, if your child does not have any significant developmental challenges and is meeting developmental milestones, then this is a good time for a reasoned discussion. It is important to think about the impact on your family. Not every family wants to pursue ear tubes. In my practice, when the family comes to see me for recurring ear infections, families are all over the decision board on surgery. Some families absolutely want to have tubes be placed. Some families are adamantly against it. And some families are completely unsure about what they want to do. And that’s OK.
The Best Decision For Your Family
Parents often want to pursue the most conservative course. But what is the most conservative course? Is it to avoid surgery? Is it to avoid more ear infections and possible [systemic antibiotics], potential antibiotic resistance or hearing loss? The answer will vary based on the patient and family, more than the surgeon. There are times when I will think there is a most appropriate course. I may try to offer guidance (thinking together about the impact on you and your child’s life). Consequently, my visits are often longer. I truly want to know that this will be beneficial, and that you and I have the same hopes/expectations.
Ultimately, I hope that we can come to a decision together. The question is not what would be the best decision for my family, but what is the best decision for yours.