Q. My toddler gets frequent ear infections, and his doctor wants me to consider ear tubes. What do I need to know before I make a decision?
A. Ear infections are very common and can make children miserable. Most go away and don't cause problems, even without treatment. But a few can lead to complications, including more serious infections of the bone near the ear or even the brain.
Also, many ear infections in a child can lead to hearing loss. Often the hearing loss is temporary, but if it occurs when a child is learning to talk, it can make it difficult for the child to acquire language.
Ear infections are often caused by the failure of a little tube called the Eustachian tube to work as it should. This tiny tube connects the inner part of the ear to the nose. It keeps the air pressure in the ear the same as the pressure in the nose and the air around us.
However, in many young kids whose heads are growing, the tube can get twisted and partially blocked. Negative pressure forms in the ear. This sucks bacteria that live in the nose up into the ear, causing an ear infection. Then, because the tube is partially blocked, the infection cannot drain out of the ear and into the nose.
Surgery is recommended for recurring or persistent infections, particularly if a child has hearing loss. There are about a million ear surgeries in kids each year in North America.
The most common surgery is to insert tiny plastic tubes through the eardrum while the child is under anesthesia. These tubes essentially do what the Eustachian tube should: They keep the pressure in the middle ear the same as in the air around the child, which reduces the tendency of infected fluid to get into the ear. Also, if an infection does develop, the infected ear fluid can drain into the outer ear and out of the body. The surgery is called a myringotomy. It is quick, usually less than 15 minutes.
As with any surgery, there are risks, but they are minimal. There are always some risks with anesthesia. But because the procedure is so quick, there isn't much anesthesia required. There is also the risk that the hole made in the eardrum won't heal, but this is rare and can be fixed. Most children go home once they're awake and feel well enough to leave. Your child may be a bit groggy, cranky or nauseated from the anesthesia.
Most tubes fall out within a year or two, sometimes sooner. They are so tiny that they generally slip out unnoticed. Rarely, they have to be removed. It's often OK if the tubes fall out, because as the child's head grows, the Eustachian tube starts to work again. The little myringotomy tubes have served their purpose.
• Dr. Komaroff is a physician and professor at Harvard Medical School. Submit questions or get additional information at AskDoctorK.com.