Ear infection may need surgery
DEAR DOCTOR K: My toddler gets frequent ear infections. His doctor wants me to consider surgery, but that seems much too aggressive to me. Am I wrong?
DEAR READER: I’m not sure what kind of surgery your pediatrician is recommending, but I’ll bet it involves putting in ear tubes. I’ll explain that below.
Ear infections are very common and can make children miserable. Most go away and don’t cause problems, even without treatment. But a few can lead to complications, including more serious infections of the bone near the ear or even the brain.
Also, many ear infections in a child can lead to hearing loss. Often the hearing loss is temporary, but if it occurs when a child is learning to talk, it can make it difficult for the child to acquire language.
Ear infections are often caused by the failure of a little tube called the Eustachian tube to work as it should. All of us have this natural tiny tube, which connects the inner part of our ears to our nose. The Eustachian tube keeps the air pressure in the ear the same as the pressure in the nose and the air around us.
However, in many young kids whose heads are growing, the tube can get twisted and partially blocked. Negative pressure forms in the ear, sucking bacteria that live in the nose up into the ear and causing an ear infection. Then, because the tube is partially blocked, the infection cannot drain out of the ear and into the nose.
If your child has had recurring or persistent infections, particularly if your son has hearing loss, minor surgery can protect him. The most common surgery is to insert tiny plastic tubes through the eardrum. These tubes essentially do what the Eustachian tube should: They keep the pressure in the middle ear the same as in the air around the child, which reduces the tendency of infected fluid to get into the ear. Also, if an infection does develop, the infected ear fluid can drain into the outer ear and out of the body. The surgery is called a “myringotomy” (pronounced meer-in-GOT-a-me). It is quick, usually less than 15 minutes.
As with any surgery, there are risks, but they are minimal. Before the surgery, your son will be given medicines that make him temporarily very sleepy, and he won’t feel or remember the brief surgery. There is a small risk that the hole made in the eardrum won’t heal, but this is rare and can be fixed. 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 medicines.
Most tubes fall out within a year or two, sometimes sooner. They are so tiny that they generally slip out unnoticed. Rarely, they have to be removed. It’s often OK if the tubes fall out, because as the child’s head grows, the Eustachian tube starts to work again. The little myringotomy tubes have served their purpose.
(This column is an update of one that ran originally in October 2012.)
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)