February 15, 2010
By Claire McCarthy, M.D.
Boston Children's Hospital
Ear infections can make children miserable. Any parent who has sat up all night with a child crying in pain with an earache can tell you that. And when the earaches happen again and again, it's even worse. But when the doctor starts talking about surgery, well, that has a way of striking fear into a parent's heart.
Ear infections are very common. More than 90% of children get at least one; some children have many more than that. And while most ear infections go away and don't cause problems, they can lead to complications. For example, if the infection doesn't heal, it can lead to more serious infections. Also, when a child has many ear infections it can lead to hearing loss. Often the hearing loss is temporary. But if it comes at a time when a child is learning to talk, it can be a problem.
Ear infections happen when a little tube called the Eustachian tube doesn't work. This tiny tube connects the middle ear with the back of the throat, and prevents fluid from backing up inside the ear. When the tube gets clogged or blocked, fluid builds up and can get infected with bacteria and cause infection. In children, the Eustachian tube is more likely to get clogged, and some children are more susceptible.
As children get older, the Eustachian tube usually starts to work more reliably on its own. Ear infections become less common. But some children need surgery to help the process. Doctors consider surgery when:
- A child has middle ear fluid for three months or longer, and has a hearing loss
- An ear infection is very severe, and won't go away despite antibiotics, especially if there are signs that the infection has spread beyond the ear
- The ear drum is chronically retracted (pulled in) and there are signs of a complication called a cholesteatoma
The most common surgery for ear infections is to insert myringotomy tubes into the eardrum. These tiny (and I mean tiny!) tubes are placed while the child is under anesthesia. The surgery is quick around 15 minutes or less. These tubes essentially do what the Eustachian tube should: They prevent build-up of pressure in the middle ear.
As with any surgery, there are risks but they are minimal. Your doctor will talk to you about the risks of anesthesia. But because the procedure is so quick, there isn't much anesthesia required. There is also the risk that the hole made in the eardrum won't heal. This, however, is rare and can be fixed if it occurs. Infection can occur, but this can generally be prevented and treated.
Most children go home once they're awake and feel well enough to leave. Your child may be a bit groggy, cranky or nauseated from the anesthesia, but there's usually no pain from the procedure. In fact, children who've had chronic pain from buildup of pressure in the ear may feel better immediately!
Because the tube creates a connection into the middle ear from the outside, it's possible that germs could enter. So your doctor may prescribe antibiotic drops to use for a few days. You should definitely call your doctor if you see fluid coming out of the ear. It's also possible for germs to enter if water gets into the ears. While this is unlikely unless you are diving or swimming in dirty water, you should talk to your doctor about when your child should use earplugs, and what kind.
Most tubes fall out themselves within a year or two, or sometimes sooner. They are so tiny that they generally slip out unnoticed, often after getting stuck in earwax for a while. Sometimes they have to be removed, but this is rare.
For more information, visit the American Academy of Otolaryngology website.
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Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.