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Should my toddler have ear tubes inserted to prevent ear infections?

Posted Oct 01 2008 8:12pm 1 Comment

The inner ear is full of air and is connected to the outside through the eustachian tube that opens into the back of your mouth. Young children have narrow eustachian tubes that can close and fill with fluid that causes ear pressure and pain. If your doctor sees fluid causing the ear drum to bulge outward, he knows that the eustachian tube is closed and often prescribes antibiotics and a cortisone-type nasal spray. Antihistamines do not open eustachian tubes. Doctors sometimes remove tonsils and adenoids or give allergy injections, but these treatments have an extraordinarily high failure rate.

Since the eustachian tube enlarges as a child grows, the tube usually opens by itself in time and it is rarely necessary to perform surgery. However, if the doctor feels that fluid in the drum can interfere with a child's hearing or school work or that permanent damage in possible, it is reasonable to relieve this pressure by punching a hole in the ear drum and inserting a tube to keep it open. Research shows that the buildup of fluid in the inner ear is probably caused by inactive cilia, the small hairs that line the eustachian tube and sweep fluid toward the mouth. Erythromycin antibiotics can stimulate the cilia, remove fluid from the inner ear and help to relieve the discomfort.

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Here are the reasons to put tubes in a child's ear from the American Academy of Otolaryngology;

1)Severe hearing loss in patient with ear infection. 
2)Poor response to antibiotic for middle ear infection.
3)Impending mastoiditis or intra-cranial complication due to middle ear infection.
4)continuous fluid in middle ear (doesn't need to be infected) > 3 months
5)Recurrent episodes of acute middle ear infection (more than 3 episodes in 6 months or more than 4 episodes in 12 months) 
6)Chronic retraction of tympanic membrane or pars flaccida (in other words, a floppy eardrum, due to poor eustachen tube function)
7)Craniofacial anomalies that predispose to middle ear dysfunction (e.g., cleft palate).


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