It’s hard to say for sure which kids will benefit most from a common childhood surgery for infections and fluid buildup in the middle ear, a research review suggests.
The reviewers focused on a procedure known as tympanostomy, surgery to place tiny tubes in the eardrum that help improve air flow and prevent fluid accumulation in the middle ear. They looked at both what’s known as otitis media with effusion, or chronic accumulation of fluid that’s not infected, as well as recurrent acute otitis media, or a buildup of infected pus that can be painful and put pressure on the ear drum.
The study team analyzed data combined from 147 previously published articles on the surgery and found it associated with less short-term hearing loss in kids with a chronic buildup of uninfected fluid but no evidence of benefit by 12 to 24 months compared to children who didn’t get the treatment.
Kids with acute infections may have fewer episodes after surgery, but evidence is limited, the review also found. The limited data makes it hard to draw conclusions about which kids may benefit most from ear tubes, said lead author Dr. Dale Steele of Brown University in Providence, Rhode Island.
“Tubes might be most effective in young children less than three years of age who are in daycare, and in older children with persisting hearing impairments for at least 12 weeks,” Steele said by email.
Fluid in the ear can sometimes be accompanied by temporary hearing problems, and when it’s infected it can be quite painful. The fluid may go away without treatment within a few weeks or months, but when fluid remains in the ear for more than three months it can exacerbate other problems with speech, language and learning.
Ear tube surgery is very common in the U.S., with an estimated 667,000 kids under 15 years of age getting the procedure each year, the authors note in Pediatrics.
For otherwise healthy children, doctors often advise parents not to consider ear tubes until after they’ve waited at least a few months to see if problems resolve without surgery. The study findings suggest that this cautious approach is warranted, Steele said.
When kids have uninfected fluid, the American Academy of Otolaryngology-Head and Neck Surgery recommends surgery only after at least three months of fluid buildup when kids have documented hearing problems or when children have issues with things like balance, behavior or school performance that might be tied to their ear issues.
When that ear fluid is infected, the American Academy of Pediatrics recommends surgery only for multiple infections: three episodes in six months or four episodes in a year with the last one occurring within the previous six months.
One limitation of the study is that researchers didn’t have enough data to assess which kids would benefit most from surgery, the authors note.
“What is interesting and revealing from this review is that, for a very common childhood disease such as ear disease, there are still many unanswered questions,” said Dr. Kenneth Whittemore, Jr. of the Department of Otolaryngology and Communication Enhancement at Boston Children's Hospital.
“It is clear that more studies are needed to determine which children are good candidates for the placement of tympanostomy tubes for middle ear disease,” Whittemore, who wasn’t involved in the study, said by email. “Watchful waiting is almost always an option to be offered unless there is a medical urgency requiring the immediate drainage of fluid.”
Because this surgery is generally elective, parents should be sure to question doctors about the necessity before consenting to the procedure, said Dr. Richard Rosenfeld, chairman of Otolaryngology at State University of New York Downstate Medical Center in New York City.
“Parents should never do it if they have doubts or concerns,” Rosenfeld, who wasn’t involved in the study, said by email. “In that case, they should follow up with their doctor every six months to monitor the fluid, hearing and eardrums to see if anything changes that would argue for, or against, tube insertion.”
SOURCE: bit.ly/2pGtIQf Pediatrics, online May 16, 2017.