Children’s of Mississippi physicians share facts on children’s ear surgery

Published on Wednesday, February 1, 2023

By: Annie Oeth, aoeth@umc.edu

Ear infections are among typical childhood maladies, but too many of them could be a sign that a child needs ear tube surgery.

“Ear tube surgery is needed when the eustachian tube, which is responsible for ventilating the middle ear space, is not working well,” said Dr. Mark Reed, professor and chief of pediatric otolaryngology at the University of Mississippi Medical Center. “This leads to increased rates of ear infections and is extremely common in babies and young children.”

The two most common reasons for placement of tubes are recurrent ear infections and fluid that remains in the middle ear, behind the eardrum, for three months or more.

“For recurrent infections, we typically want to see more than three infections within a six-month period,” Reed said. “For perspective, the average young child will have one infection in a year.”

Fluid remaining in the middle ear can produce a hearing loss that’s like placing your finger in your ear, he said. “That’s enough to interfere with speech and language development. That’s why we need to consider tubes in those cases to return the hearing to normal.”

Other reasons why tube surgery, or myringotomy, should be considered include persistent infections that do not respond to antibiotics, paralysis of the facial nerve, meningitis secondary to an ear infection, and infection involving the mastoid area behind the ear.

While winter is often thought of as a time when children have ear infections, the condition – and the need for ear tube surgery – is constant throughout the year.

“As much as we think about ear infections being more common in the winter months, we actually see infections throughout the year,” Reed said. “Rates of otitis media (ear infections) in the spring and fall are very close to winter levels, and a number of children continue to have infections in the summer months.”

Children who are in daycare can have more ear infections since otitis media is a secondary infection from an upper respiratory tract infection. Children in group settings have more opportunities to contract these infections.

“There is not much that we can do to stop that,” Reed said. “When children are around other children, they tend to get sick a lot no matter what time of the year it is.”

Younger children and babies are more at risk for ear infections because of the immaturity of their Eustachian tubes. Other risk factors include exposure to cigarette smoke and craniofacial conditions such as cleft palate.

Pediatrician Dr. Billy Boldon, who sees patients for conditions including ear infections at Children’s of Mississippi’s Greenwood clinic, said the risk of otitis media can also be reduced by breastfeeding children up to at least 6 months of age and not putting babies to bed with a bottle or propping a bottle when feeding.

Flu vaccinations can also help, Boldon said.

“If a child is 6 months old or older, influenza vaccine has a benefit by decreasing upper respiratory infections and therefore may decrease secondary otitis media incidence,” he said.

Most ear tube surgeries are needed in children 1 to 3 years old, but the remnants of the COVID-19 pandemic have had an impact.

“Interestingly, this year we have been seeing children who are a little older that are needing tubes,” Reed said, “probably because they were initially isolated during the pandemic and are now catching up on the illnesses that they would likely have had as a baby. It has not been unusual to see a 3-year-old who didn’t have substantial problems early on who now needs tubes. This is something that I have not seen in almost 30 years of practice.”

Reed wants to reassure parents whose children may need ear tube surgery.

“First, if you were ever going to pick a surgery for a child, this would be the one to pick,” he said. “The entire procedure takes around 10 minutes, and we don’t need to start an IV or place a breathing tube. The child goes to sleep in about 30 seconds by breathing into a mask with anesthesia gas.”

The Children’s of Mississippi team works to make the procedure easy for children and their parents.

“Because this is likely to be the first surgery that young parents will have with their children, we do everything we can to prepare them for the experience,” Reed said. “Most are surprised by the speed and ease of the procedure and are very pleased with the results.”

The effects are immediate. “It’s as close to instant gratification surgery as it gets,” he said. “They can immediately hear better and all the pressure from an infection is instantly resolved. It’s as if someone just turned up the volume on the radio.”

After surgery, “the child is usually back to normal within an hour or two. There is no healing needed from the surgery. The tube itself is placed through a small incision in the eardrum to create an opening to ventilate, and it generally stays in for around a year or so. The tube falls out on its own except in a small number of cases.”

To make an appointment, visit umc.edu/childrens or call (888) 815-2005. The physician-to-physician phone line is (866) 862-3627 (866-UMC-DOCS).

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