Delaying ear tubes -- which are used to prevent ear infections -- does not hurt a child's development, say experts.
"If tubes were completely harmless there would be no problem with giving tubes to everyone," researcher Jack Paradise, MD, of Children's Hospital of Pittsburgh, tells WebMD.
"But the point is that they are not harmless. There can be complications and risks associated with tube placement."
Researchers found no major difference in speech or learning development among children who got ear tubes as toddlers soon after diagnosis for persistent middle-ear fluid and those treated with tubes months later.
No Symptoms, No Tubes
Each year in the U.S. hundreds of thousands of children younger than age 3 have ear tubes inserted to help clear the fluid from the middle ear and prevent future ear infections.
The new report does not address the usefulness of tubes for the treatment of kids with repeated painful ear infections. But it does suggest that tubes may not be an appropriate option for otherwise healthy children who simply have persistent middle-ear fluid, says Paradise.
Paradise and colleagues closely followed 429 infants that had middle-ear fluid for at least three months.
The infants were either treated with tubes immediately or followed for up to nine months before tubes were inserted if the problem persisted.
The children were six years old at the latest evaluation.
The researchers found no differences in development of mental function, speech, and language between the two groups. The study is published in the Aug. 11 issue of The New England Journal of Medicine.
'Watchful Waiting' Best
While it was once common practice to put tubes in the ears of children with persistent fluid buildup but no symptoms, this is no longer the case, says pediatric ear specialist Richard M. Rosenfeld, MD.
Rosenfeld helped write guidelines issued by the American Academy of Pediatrics (AAP) last year calling for a "watchful waiting" approach to treating middle-ear fluid buildup. He is director of pediatric otolaryngology at Long Island College Hospital in Brooklyn. N.Y.
While acknowledging that persistent buildup can affect hearing and lead to speech, language and/or learning delays, the AAP panel noted that fluid buildup resolves without treatment in most children before such problems occur.
"This study was planned in the 1980s, and there has been a very radical change in how we use tubes since then," Rosenfeld tells WebMD. "These days, physicians do a much better job of giving tubes to the kids who actually need them."
High-Dose Antibiotics
Rosenfeld and Paradise agree that tubes can be an appropriate alternative to treatment with antibiotics in young children who have frequent ear infections.
Paradise says children who have at least three infections in six months or four infections in a year may be good candidates for tubes.
California pediatrician Robert Allison, MD, tells WebMD that he has had better success in recent years using very high doses of the antibiotic amoxicillin to treat young children with frequent ear infections.
"I haven't sent any 1- to 3-year-olds for tubes in several years," Allison says. "[High-dose amoxicillin] seems to be a very effective and well-tolerated treatment."
By Salynn Boyles, reviewed by Michael W. Smith, MD
SOURCES: Paradise, J.L. The New England Journal of Medicine, Aug. 11, 2005; vol 353: pp 576-586. Jack L. Paradise, MD, department of pediatrics, University of Pittsburgh and Children's Hospital of Pittsburgh. Richard Rosenfeld, MD, director of pediatric otolaryngology, Long Island College Hospital, Brooklyn, N.Y. Robert Allison, MD, pediatrician, Kaiser Permanente Panorama City Medical Center, Panorama City, Calif. American Academy of Pediatrics 2004 policy statement on the treatment of otitis media with effusion.
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