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 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.
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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: http://bit.ly/2pGtIQf Pediatrics, online May 16, 2017.
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