Parents of children with frequent ear infections are familiar with the routine: sleepless nights and frequent visits to the doctor’s office, often accompanied by rounds of oral antibiotics.
For some, the doctor will recommend ear tube placement surgery, which can bring a sense of relief, especially if they have already had a child who underwent tube placement.
For others, although they are excited about the idea of something that can reduce the number of ear infections in their child, this can be a stressful time as well.
Five out of six children will have at least one ear infection by their third birthday. These infections can be quite painful, but fortunately for most children, this doesn’t become a chronic problem.
When ear infections or fluid in the middle ear become chronic problems (which may lead to hearing loss, speech problems, behavior problems, or difficulty in school), placement of ear tubes by an otolaryngologist may be considered as a treatment option.
In the United States, over 800,000 tube placement surgeries are done each year. Benefits of ear tube placement may include reduction of future ear infections, restoration of normal hearing and balance, and improvement in sleep and behavior problems.
So what happens during the procedure?
The process for tube placement often requires a general anesthetic given via a mask and takes approximately 10-15 minutes. Using a microscope for visualization, any rocks, toys, or food are removed from the ear canal. (Some kids consider the ear canal a nice storage unit). A small knife is used to make an opening in the eardrum. Fluid is then suctioned from the middle ear, and a pressure equalizing tube is placed in the opening of each ear.
What should I expect after the surgery?
Many parents are nervous before the surgery and are usually surprised at how quick the procedure is. They are eager to be reunited with their child, and are very curious about the condition of the ears at the time of surgery. When there is fluid in the middle ear, they want to know if the ears will continue to drain fluid for a period of time.
Regarding the anesthesia, most parents are curious as to whether their child will sleep for a while, or become a wild, unrecognizable small person. In my experience, most kids do very well with the short, inhaled anesthetic, and are “back to normal” within hours.
Until recently, it was common practice for your surgeon to place antibiotic ear drops in the ears at the time of surgery, and ask that you continue giving ear drops to the child for a few days after the surgery as well. Now, there is a single-dose antibiotic treatment option administered by the surgeon at the time of surgery, which when used, means parents may not have to give their child ear drops after the surgery.
When I tell parents who have already been through tube placement with another child that this time I will be putting the medicine directly in the ear at the time of surgery and that they may not have to do drops at home, my popularity quickly rises.
So, why do surgeons use ear drops or a single dose antibiotic at the time of surgery?
The primary goal is to address drainage (otorrhea) from the ears after the surgery. If an ear drains prior to the post-operative visit, blockage of the tube may occur. Drainage seems to be more of a problem if the middle ear has fluid or pus in it at the time of tube placement. A significant number of kids undergoing tube placement will go back to daycare the next day, where they may be exposed to respiratory viruses, which can lead to a runny nose and another ear infection. This can result in drainage from the ear tube.
There is a challenge with administering ear drops. But, when medicine is placed in the ear at the time of surgery, the child is under anesthesia, the surgeon is using a microscope to visualize the ear, and he or she can see that the medicine has reached its intended target.
When we ask parents to use drops at home, the child is awake and moving. They are placing the drops in the ear canal (or sometimes the eye or various parts of the head if the child wiggles enough) and can’t see if they are reaching the tube at all. Most failures associated with drop therapy are simply failure of the drops to reach their intended target.
For some parents, the thought of having to do this multiple times a day over a few days after surgery can become unpleasant. At times parents will call after surgery to let us know that their child is not particularly enjoying receiving the drops, and they would like to know if they can stop using them.
Surgery can be a stressful time for parents and kids. Many of these kids have had disrupted sleep because of the ear infections, which means mom and dad are no longer sleeping through the night. They may have also received rounds of oral antibiotics for the ear infections and, by the time we meet them, are very leery of the new, smiling physician who is offering them a sticker.
If you have a child who is going to have ear tubes placed, your surgeon may offer you the option of using a single-dose antibiotic administered at the time of surgery. This may replace the need for antibiotic drops after tube placement surgery. If given the option, I’m pretty sure I know how the child would vote.