Ear Infections - Surgery

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• There were no significant differences in hearing levels between the two groups, although the children’s hearing was slightly worse than children who did not have OME.
• However, 71% of the children who received immediate M&T had tympanic membrane abnormalities compared to 43% of the children whose M&T procedure was delayed.
• Based on these results, the researchers recommended watchful waiting for young children with uncomplicated middle ear effusion (MEE).
• The data also suggest that many children with persistent, early-life MEE may later have some ear damage regardless of whether they undergo the M&T procedure.

A 2005 study found similar results. The researchers also advised against prompt insertion of tympanostomy tubes in otherwise healthy children with MEE who are younger than age 3. The researchers recommended tubes for young children who have:

• Repeated occurrences of ear infection that are not controlled well by antibiotics or that keep recurring
• Middle-ear fluid and any degree of hearing loss
• Persistent middle-ear fluid accompanied by ear pain, ringing in the ear, or eardrum structural problems

Earplugs as a Precaution. Many doctors feel that children should use earplugs when swimming while the tubes are in place in order to prevent infection. Others feel that as long as the child does not dive or swim underwater, earplugs may not be necessary. Parents should consult their own child's doctor on this subject. Cotton balls coated with petroleum jelly are effective alternatives to ear plugs. Children do not need to wear earplugs while showering.

Follow-Up. Eventually, the tubes fall out as the hole in the eardrum closes. This may happen after several months or more than a year later. It is painless. In fact, the patient and parents may not even be aware that the tubes are out.

Twenty to 50% of children may have OME relapse and require additional surgery that involves adenoidectomy and myringotomy. Tube reinsertion may be recommended for children younger than 4 years of age.

Myringotomy

Myringotomy is used to drain the fluid and may be used (with or without ear tube insertion) in combination with adenoidectomy as a repeat surgical procedure if initial tympanostomy is not successful. It is not effective as a sole surgical procedure. Myringotomy involves the following steps:

• The surgeon makes a very small incision in the eardrum
• Fluid is sucked out using a vacuum-like device
• The fluid is usually examined for identifying specific bacteria
• The eardrum heals in about a week