The Low-Down on Kids' Recurring Ear Problems

Ear tubes and adenoid surgery treat child ear condition more effectively than alternatives

(RxWiki News) Ear infections are a common part of childhood, as most parents are aware. But doctors may recommend surgery for some recurrent or serious ear conditions.

A recent study assessed the different treatment options for a condition in children called otitis media with effusion.

Otitis media is any kind of inflammation of the middle ear. However, otitis media with effusion specifically refers to a condition in which thick or sticky fluid is behind the eardrum even though there may not be an ear infection.

A child with otitis media with effusion most likely does not have pain or a fever, but the condition can lead to minor hearing loss.

"Ask the pediatrician about ear condition treatment options."

The study, led by Ina F. Wallace, PhD, of the Division for Health Services and Social Policy Research at RTI International in North Carolina, looked at treatments for otitis media with effusion.

The researchers identified 41 studies related to the treatment of this condition, pulled from four medical research databases and three reviews of the evidence.

The studies compared the following types of treatment:

  • A myringotomy, in which a small cut is made in the ear drum to release pressure and allow fluid to flow out of the middle ear.
  • An adenoidectomy, in which a child's adenoids are removed. Adenoids are lumps of tissue at the back of the nasal cavity near the tonsils.
  • Inserting tympanostomy tubes, or "ear tubes," in which a small tube is inserted into the eardrum to give the middle ear access to air and prevent fluid from building up there.
  • Watchful waiting, during which clinicians carefully observe a child's condition without doing any surgical procedures at first.

The researchers found that inserting ear tubes reduced how much time the child had otitis media with effusion when compared to watchful waiting or the myringotomy.

Use of ear tubes also improved children's hearing better than myringotomy or watchful waiting.

The researchers did not find any differences in treatment outcomes based on the type of tubes that were used.

The researchers also found that conducting an adenoidectomy — by itself or combined with either a myringotomy or watchful waiting — was also more effective in improving the condition and improving hearing than just a myringotomy or watchful waiting by itself.

When the researchers looked at children's language skill development, cognitive skills and academics, they found no differences between the children receiving ear tubes and the children undergoing watchful waiting.

The researcher also looked at possible harms or risks of the procedures.

Children were more likely to experience ear drainage or a build-up of calcium in the eardrum or middle ear if they received ear tubes.

Children who received an adenoidectomy were at a slightly higher risk for experiencing hemorrhage (bleeding) after their surgery.

However, the researchers concluded that these two treatments — ear tubes and an adenoidectomy — were the most likely of the four treatment to improve the condition and a child's hearing.

The researchers recommended that additional studies look more closely assess the benefits and the risks in terms of a child's quality of life, hearing outcomes, recurrence of the condition and long-term experiences.

According to Thomas Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, Mass., drainage is the primary goal when dealing with ear infections.

"Using warm packs and decongestants is the usual treatment for ear infections in children older than 2 years old," he said. "This is different than watchful waiting and has been shown to be very effective."

However, that treatment may not always be sufficient.

"When there is a lot of nasal congestion, the adenoids can increase in size and obstruct the Eustachian tubes, which provide drainage of the middle ears," Dr. Seman said. "These are the same tubes one uses when holding their nose to 'pop the ears.'"

Dr. Seman noted that a myringotomy removes the fluid behind the ear drum, instantly improving hearing, but the procedure heals quickly, so fluid can re-accumulate over time.

"Tubes are very effective and last on average for nine months," he said. "They help keep fluid draining but trying to keep an active child's ears dry while bathing, swimming and similar activities is hard."

Dr. Seman noted that follow-up studies will probably look at the risks associated with the surgery and the change in lifestyle to keep children's ears dry. The procedure may be appropriate for children with frequent ear infections, but not for typical children with few ear infections during their first five years, he said.

This study was published January 6 in the journal Pediatrics. The research was funded by the US Department of Health and Human Services and RTI International. The authors reported no conflicts of interest.

Review Date: 
January 10, 2014