Ear Surgery

Ear tubes don't make a difference in learning
Study delivers blow against common childhood procedure

Children are frequently prescribed ear tube surgery with the rationale that the surgery preserves normal learning and behavior through primary school A recent study, however challenges this practice with evidence contrary to routine pediatirc practice.

Read the article in its entirety here:
http://www.msnbc.msn.com/id/16673576/

Ear Tubal Surgery for better Hearing: A Look at the facts.

The team enlisted 6350 healthy babies from birth to 2 months old and have regularly measured fluid in these children’s ear up until their third birthdays. If children developed significant fluid in the ears that lasted for at least 3 months straight or 4 out of six months, half of the children received ear tube surgery. The other half waited for 6 to 9 months longer and then had surgery only if the fluid remained. What was the outcome? When the children were 4 years old, they received an extensive battery of intelligence, development, speech, language, and behavioral tests, looking at verbal and nonverbal growth. No difference could be found between the early and late treatment groups. Researchers will continue to follow these children as they grow up. But for now, this large, carefully designed study has found no developmental benefit from rushing to ear tubes for young children.

-August 2003 Pediatrics. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12897272

Their more recent study confirms that the surgery in 2-3 year olds does not improve hearing abilities when they reach 5-6 years of age. "In otherwise healthy children who have persistent MEE during their first 3 years of life, ready resort to M&T results in far more TM abnormalities at age 5 than does selective management in which most children do not receive the procedure. With these differing approaches, however, hearing levels at age 6 do not differ. Regardless of whether children with persistent early-life MEE receive M&T, they have more TM abnormalities at age 5 and negligibly poorer hearing at age 6 than do children who had less or no otitis media. "

-July 2004 Pediatrics
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15231974

Adenoidectomy not more effective with Ear Tubal Surgery

In children younger than 2 years, concurrent adenoidectomy during the insertion of tympanostomy tubes does not seem to have a major advantage over the insertion of tympanostomy tubes alone in preventing otitis media.

Mattila PS, Joki-Erkkila VP, Kilpi T, Jokinen J et. al   Prevention of otitis media by adenoidectomy in children younger than 2 years   Arch Otolaryngol Head Neck Surg 2003 (Feb);   129 (2):   163-168

 

Ear Tubes do not Decrease Antibioic Treatment

Parental expectations to antimicrobial treatment and awareness about resistance development appear to influence treatment strategies for AOM. The high rate of tympanostomy tube placement in preschool children does not result in reduced antimicrobial consumption.

Arason VA, Sigurdsson JA, Kristinsson KG, Gudmundsson S   Tympanostomy tube placements, sociodemographic factors and parental expectations for management of acute otitis media in Iceland   Pediatr Infect Dis J. 2002 (Dec);   21 (12):   1110-1115

 

Ear Tubes not Necessary after 16 months of age

Spontaneous recovery from recurrent acute otitis media is common with increasing age. Thus, until reliable causal evidence between recurrent otitis media and developmental disability is presented, chemoprophylaxis or tympanostomy tubes seem superfluous for most infants after the age of 16 months.

Alho OP, Laara E, Oja H   What is the natural history of recurrent acute otitis media in infancy?   J Fam Pract 1996 (Sep);   43 (3):   258-264

 

Ear Tubes Not Worth the Risk or Cost

Implanting ear tubes, an operation done on hundreds of thousands of toddlers each year, does not appear to improve their speech and learning development and may not be worth the risks and the cost, a study suggests.  Researchers in Pittsburgh looked at two groups of toddlers: those who got ear tubes after three months of fluid in their ears (the standard guideline) and those who waited up to nine months before tubes were inserted. The children were tested for speech, language, learning and behavior when they turned 3.  "The bottom line was there wasn't any difference in the developmental outcomes as best we could measure them at age 3," said Dr. Jack L. Paradise of Children's Hospital of Pittsburgh.

Paradise said there is a risk of complications from the anesthesia. Also, he said, the tubes sometimes leave perforations in the eardrums or scar them, or cause chronic drainage from the ear.  "If tubes were absolutely harmless and free, then I think you might say, 'Well, let's have the tubes to be sure,"' Paradisesaid. "But tubes themselves carry risk and, of course, there's cost  involved. So it becomes a matter of ... which set of risks would you rather take?  Paradisesaid he would hold off inserting tubes if the only concern was developmental problems from hearing loss.

Hoffman RA, Madell JR   Effect of early or delayed tympanostomy-tube insertion for persistent otitis media   N Engl J Med 2001 (Aug 9);   345 (6):   465;   author reply 465-6

 

Tubes in the Ear Not Beneficial

Whether or not to give a child tympanostomy tubes.... tubes in the ears... is a debate that has raged in medicine for two decades.  One of the major arguments in favor of tubes is that if children have fluid behind the middle ear it can cut down on their ability to hear and potentially lead to learning problems.  But a report in the New England Journal of Medicine says this is not the case.  According to the report, in children younger than 3 years of age who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes.  The procedure has little long-term benefit with respect to hearing behavior or learning and development.

Paradise JL, Feldman HM, Campbell TF, et. al.   Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years   N Engl J Med 2001 (Apr 19);   344 (16):   1179-1187

 

Tube Surgery both Expensive and Frequently Ineffective

Myringotomy and tympanostomy with tube implantation are frequently both ineffective and expensive.

Gates GA; Wachtendorf C; Hearne EM; Holt GR   Treatment of chronic otitis media with effusion: results of tympanostomy tubes   Am J Otolaryngol 1985 (May);   6 (3):   249-253

Gates GA; Wachtendorf C; Hearne EM; Holt GR   Treatment of chronic otitis media with effusion: results of myringotomy   Auris Nasus Larynx. 1985;   12 (Suppl 1):   S262-264

 

Another Reason to Avoid Ear Surgery

According to researches at Children's Hospital of Pittsburgh and the University of Pittsburgh, Inserting tubes in the eardrums of children under the age of 3 has no measurable effect on improving speech, language, cognitive or psychosocial development.

The researches studied 588 3 year olds from infancy and concluded that their findings provided no evidence that the insertion of ear tubes improves a child's developmental progress. Approximately 280,000 children under the age of 3 have tubes inserted annually.

Before Ear Surgery read this: What are risks and complications of ear tubes? http://www.medicinenet.com/ear_tubes/article.htm

Consider chiropractic before ear surgery

The Otitis Media Page @ Chiro.Org

Please Visit: http://www.chiroweb.com/archives/12/20/04.html for an additional article on treatment of Otitis Media