July 1st, 2013
06:19 PM ET
Parents of young children may be all too familiar with the ear aches, ear infections, and middle ear fluid build-up that can plague their little ones.
For many of these children, ear tubes, known clinically as tympanostomy tubes, may be the best treatment. But until now, there has been no clinical guideline to advise doctors and parents on which children should - or should not - receive them. A multidisciplinary panel associated with the American Academy of Otolaryngology – Head and Neck Surgery Foundation (also known as AAO-HNSF) has changed that, releasing new guidelines on Monday.
"You've got the number-one ambulatory surgery in kids, the number-one reason they are given anesthesia, and no national society has ever published evidence-based guidelines about the best way to do this," said Dr. Richard Rosenfeld, a professor and chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, New York.
"It seemed like a huge deficit," said Rosenfeld, who chaired the AAO-HNSF panel.
Who should get ear tubes?
The guideline addresses ear tubes in children ranging in age from 6 months to 12 years. It was written by a panel of specialists that included pediatricians, a nurse practitioner, an anesthesiologist, a speech pathologist, consumer advocates and ear, nose and throat specialists, among others.
According to the guideline, children who have very frequent ear infections and who also hold on to fluid - meaning their infections don't clear up quickly - are candidates for ear tubes. However, the guideline says tubes should not be given to children who have frequent ear infections but who do not have fluid build-up - a major deviation from what typically happens in clinical practice.
"This is one of the most new and significant things being recommended," said Rosenfeld. "You have to distinguish between the kids whose infections clear up completely and the ones who hold on to fluid."
That means parents should question doctors on whether their child's ears contain fluid, Rosenfeld said. If they do not, according to the guideline, ear tubes should be avoided.
In addition, children who have had fluid build-up in both ears for more than three months and are experiencing difficulties such as not hearing well in loud group situations or listening to someone speak who is not looking at them - a teacher writing on a chalkboard, for example - should also be offered tubes, according to the guideline. That also goes for children who have had fluid build-up for more than three months in only one year, but whose quality of life is being affected by it, Rosenfeld said.
"There's an effect on gross motor skills, on a child's balance," he explained. "Fluid that is affecting your equilibrium benefits from tubes."
Children who are at higher risk for fluid build-up-related developmental delays should also be given tubes. That includes children diagnosed with autism, permanent hearing loss, Down syndrome or any other developmental delay.
How they work
The small tubes, about 1/20th of an inch, are placed at the end of a child's ear canal while the child is under light general anesthesia. They're designed to alleviate any fluid build-up by allowing air to pass into the child's middle ear to ventilate and eliminate the pressure inside that space.
Children with tubes are able to play in the water, swim, and bathe without wearing ear plugs - something that isn't common knowledge, according to Rosenfeld. Children swimming in water at least six feet deep are the only ones who should be concerned with wearing ear protection, he said.
"That advice is given under the common-sense pretense that water can get in to the tube ... but that's not the case," he said. "Water simply does not pass through a hole that small easily."
Children should not be able to feel the tubes while they have them and over time, they should fall out on their own as wax and debris build up inside the ear.
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