Totally Tubular or Not

So we just got back from the Ear, Nose and Throat doc and it looks as is our lil guy will be getting tubes in his ears. We cannot help but to have some trepidation about this decision, but feel it is in his best interest to get done. From all the research we have done and from what the doc says, it is a routine operation and takes minutes to do.

From folks that Mama T has talked to, they all swear by it and say that it helped their child with their hearing, speech development and reduction in ear infections. The only negative I have heard is from my mom whose neighbor experienced deafness in one of her ears as a result of getting tubes. We discussed all of this with the doctor too.

He said our lil guy is a prime candidate for tubes because of the amount of fluid he still has in his ears even after getting a shot last week and still on antibiotics... his fourth different variety I might add. The doc did tell us that he would never advise putting ear numbing drops in children's ears... which we found very interesting because we have been given three prescriptions for them by our pediatrician. He just said personally that he would rather us give him Motrin or Tylenol to ease the pain.

He did say that our pediatrician did do the right thing in continually prescribing antibiotics, because that is the protocol for recurrent ear infections and sooner or later we would have ended up in his office. Mama T and I went into our lil guys last doc appointment knowing we were going to seek the name of a good Ear, Nose and Throat doctor.

So this lead me to do some research as to the rise of ear infections in our children today. What I found out was very interesting...

So why the increase in ear infections?

According to the University of Maryland Medical Center, "The rise in ear infections has paralleled the increasing incidences of other upper and lower airway disorders such as Asthma, Allergies, and Sinusitis. For example, the same bacteria are often responsible for both ear infections and sinusitis. In one study, 38% of children with ear infections also had sinusitis, and other studies have reported that nearly half of children with Otitis Media have concurrent sinusitis. Data indicates that nearly a third of infants and toddlers with upper respiratory infections go on to develop acute Otitis Media. Researchers are looking for common risk factors, such as:

• Increase in Day Care Center Attendance. Although ear infections themselves are not contagious, the respiratory infections that precipitate them can pose a risk for children with close and frequent exposure to other children. Some experts believe that the increase in ear and other infections may be due to the higher attendance of very small children, including infants, in day care centers beginning in the 1970s. Research presented at a 2006 pediatric medicine meeting suggested that it may be wise to keep very young children (under 1 year old) out of day care to avoid exposure to the upper respiratory infections that can lead to ear infections.
• Increase in Allergies. Some experts believe that an increase in allergies is also partially responsible for the higher number of ear infections, which is unlikely to be related to day care attendance. Studies indicate that 40 - 50% of children over 3 years old who have chronic Otitis Media also have allergic rhinitis (hay fever). Allergies can cause inflammation in the airways, which may contribute to ear infections. Allergies are also associated with asthma and sinusitis. However, a causal relationship between allergies and ear infections has not been definitively established." Nor has it been determined if poor indoor air quality is linked to the increase in allergies.
• Breast-feeding, "rather than formula-feeding, is one important preventive measure. Studies show that breast-feeding for at least four months cuts the number of ear infections in half."

According to Dr. Mary Ann Block of the Block Institute, other risk factors that are currently being studied are:

• Smoking and air quality. "Smoking is another factor that raises the risk of ear infections. Tobacco smoke can irritate the mucous membranes in the nasal passages, causing them to swell. This increases the likelihood of fluid getting trapped in the middle ear. Even fragrances, cologne, and air fresheners can irritate the mucous membranes.
• Genetic Factors. Children who have had previous ear infections are at greater risk as well as children with a family history of ear infections. Children born prematurely or with a low birth weight also are at greater risk. And, interestingly enough, if your child is male there is a higher risk of ear infections (boys tend to get more ear infections than girls) or if your child has a nasal speech (caused by large adenoids that block the Eustachian tube) they are also at risk.
• Nighttime Bottle. Taking a bottle to bed at nights.
• Pacifiers. Pacifiers can also increase the incidence of ear infections. It is not understood whether this is because pacifiers are not properly cleaned, or because the sucking motion causes bacteria to flow upward into the Eustachian tube."
• Food Allergies. Doctors have suggested that up to 1/3 of all cases of ear infections are due to dairy or milk allergies. Other foods may be suspect, but the connection between dairy and ear infections is one of the first places to start a food elimination program.

Read more: http://www.healthy-holistic-living.com/ear-tubes.html#ixzz0ebVtPg

It is interesting because our son has been in daycare since he was three months old and he sleeps with 3 sometimes 4 pacifiers. He doesn't constantly have the pacifiers in his mouth while he sleeps though which is a good thing I guess.

So the next thing I was curious about was the pros and cons of the tubes... well this same site has a good list of those too.

The pros and cons of tympanosotomy ear tubes:

Often times when a child experiences chronic ear infections or chronic fluid in the ear, he or she will be referred to the Otolaryngologist to place tympanosotomy tubes in the ear, a surgical procedure. Usually, doctors will recommend the surgery if the child has 3 episodes (ear infections) within 6 months or 4 episodes in 12 months. This is especially true if the antibiotic treatments are tried and have failed to resolve the issue. The reasoning here is that the child's recurring ear infections are due to fluid in the middle ear canal. This fluid is unable to drain down the Eustachian tube. If the fluid could drain, the bacteria would not be able to grow and cause an infection.

The issue at hand remains: to tube or not to tube…..let's identify the possible benefits and then review the possible risks or side effects.

According to Dr. Judith E. C. Lieu of St. Louis Children's Hospital, studies have shown that tympanosotomy ear tubes can improve the quality of life for children (and families) in the following ways:

• "Reduce the frequency (number in one year) of ear infections
• Reduce the severity of symptoms (ear pain, fussiness, poor sleep, hearing loss, etc) associated with ear infections
• Improve or cure the hearing loss that comes from chronic fluid in the middle ear
• Reduce caregiver anxiety about children who are often sick with ear infections
• Reduce how much antibiotic a child receives for ear infections"

Dr. Lieu states that, "although tympanosotomy ear tubes can be a wonderful help to managing ear infections and hearing loss associated with fluid in the middle ear, they do not cure ear infections and hearing loss entirely. And they can result in some complications.

• Even with tubes, children have an average of 1 to 2 ear infections per year. When ear infections occur, care givers may see drainage from the ears, which can look like the drainage from the nose when someone has the common cold or sinus infection.
• Water exposure in the ears with tympanosotomy tubes can sometimes cause ear infections, particularly when the water is dirty or contaminated (such as with bath water or lake/river/ocean water). Some type of ear plug is usually recommended when you expect a child with tubes will be exposed to dirty water.
• Persistent holes in the eardrum may exist even after the tympanosotomy ear tubes have come out on their own, sometimes requiring more surgery to repair the eardrum.
• Minor degrees of ear drum scarring happen in almost one-third of children with tympanosotomy tubes. This usually does not result in any change in the way the eardrum functions."

The key seems to find out what is most likely to be the cause of your child's ear infection and to treat the problem before tympanosotomy ear tubes become necessary. At the first sign of an ear infection, or if your child has had chronic problems in the past, it is worth considering the risk factors above and eliminating as many of the possible offenders. Especially food allergies, with over 1/3 of all ear infections being the result of a dairy allergy, it is worth investigating.

Your best defense is to be as informed as possible. Getting to know what causes ear infections, understanding your child's type of ear and knowing the risks involved in surgery will help you make the best and most informed decision for your child.

Read more: http://www.healthy-holistic-living.com/ear-tubes.html#ixzz0ebaJXmdK

The pros and cons are interesting too and make me want to pay closer attention to the foods he is eating including his milk intake. He was not properly weaned off of formula when we moved him to his new daycare months ago so now I am thinking it could possibly be some sort of milk allergy. I will have to look into this closer.

We will keep you posted on the surgery and how it goes and please know I am not abdicating the surgery one way or the other, but it is the choice we are making for our son. Our suggestion is to do as much research as possible and make the best educated decision you can.

I will add that the thing that made me feel even more secure in our decision is that the doc said he will monitor him very closely and will be available at any time to see us and answer questions.

Update on Tuesday, March 9, 2010 at 9:20PM by Mama K and Mama T

Okay - so our little guy made it through the surgery with no complications that we know of. The only scary thing that we had happen was that several days after the surgery he became ill with an upper respiratory infection that led him to have fevers for days with the highest one spiking at 105. So scary... to make matters worse his ears were still draining after all of this and we repeatedly called the doctors and no one wanted to see him. They told us to just wait the illness out. So that is what we did.

Last week we took him back to the ear doctor for a follow-up visit and they were unable to do the hearing test because of all the fluid and drainage that was still occurring. Since they couldn't do the test they put us in a room to wait for the doctor. While we waited another nurse came in and asked us how long the drainage had been going on... we told her since the surgery and she told us that was not normal. Our response to that was that we repeatedly had called doctors only to be brushed aside. We were told that they would contact the doctor if they had to do so or that it was a result of his upper respiratory infection and it would work itself out. She asked us who we talked to and we couldn't remember her name but when we told her what was said to us she knew exactly who it was based on the repeated conversation.

The doctor then came in and asked us why this was the first he was hearing of the excessive drainage... we looked at him like he was crazy and told him we made repeated attempts to contact him and he obviously never got the messages. He informed us that he had ear infections in both ears again with the tubes in and gave us some different drops to use in his ears. It cleared up the drainage in two to three days tops. Great news!!!

So here are some things we have noticed since the ear tube placement surgery...

1. He sleeps so much better through the night consistently
2. He immediately started making noises we had never heard him make before (pushes his toy cars around and makes the motor sound) So cute!!!
3. He seems so much happier at home and at school
4. We found out the other day he says a bunch of words at school and is doing extremely well with his sign language... of course he does none of that at home :-)
5. His appetite has increased again
6. Has been nice to do things with him like taking him places... it seems like he has been sick for so long it is nice to be able to go outside and enjoy the weather as it begins to get warmer.

So now only time will tell if the ear infections have cleared up for now. I will post more once he goes back for his hearing test.