Tubes

Jan 16 2012 Published by under Uncategorized

It's no secret that good, lasting relationships are formed between people who have a lot in common -- the same values, similar taste in music or films, the love of  hiking/biking/cooking/dogs/stamp collecting... But let me tell you, there is such a thing as too much in common. My husband and I share one key aspect that has caused us both many sleepless nights over the years: we both have upper respiratory tract issues. I have had sinus problems all my life, and eventually had sinus surgery in 2010. My husband spent his early childhood with numerous middle ear infections, which were handled by giving him aspirin and waiting for the eardrum to burst.

Our shared poor ear-nose history means that we have created three beautiful boys with ear-nose issues. Our first two sons started having recurrent middle ear infections within a month of starting daycare, and ended up having to get tubes. I was really, really hoping third time's the charm and we would avoid ear infections with the third child, but no such luck: sure enough,  the baby (6 mo old now) contracted his first cold after 10 days in daycare, his second after about 25 days in daycare, and that one turned into an ear infection. This was the end of November; three rounds of antibiotics later the ears are still not clear and the fluid is still present in his middle ear. One benefit of having gone through this with two older kids is seeing the writing on the wall early -- after the first round of antibiotics didn't work, I immediately requested referral to see an ENT. We finally got to see the ENT last week, and the baby will have tubes inserted this coming Tuesday.

It is very scary to have a baby go under anesthesia and endure any kind of surgery, but insertion of tubes is the kind of procedure that I feel carries really minimal risks and multiple rewards. I am not a medical doctor, but this will be our third time going for tubes, so I am fairly comfortable with the procedure and the benefits for everyone -- the baby sleeps and eats better, and we avoid: damage to hearing, speech development delays, the need to incessantly take antibiotics (and antibiotic resistance), terrible diaper rashes that can come with prolonged use of antibiotics... If the baby gets an ear infection after tube insertion, it is treated much less invasively -- with antibiotic ear drops that act topically, rather than those administered orally.

The procedure involves myringotomy (making a slit in the eardrum), followed by the removal of fluid from the inner ear by gentle suction, and finally tube placement. In my experience, the surgery takes about 15 min (both sides together). Babies wake up promptly afterwards and are famished (can't eat for hours before the surgery because of anesthesia), take a good nap shortly thereafter, and then they are as good as new. Tubes are supposed to stay in for about 9-12 months and then fall out on their own, but doctors say they can be in from 6 months to 18 months. I seem to recall that, if the tubes are still in after 18 months, they may need to be surgically removed.

Ear infections plague many a family with young kids this time of year. With kids in day care, there is no way to avoid colds; with us, every cold with a young baby is a cause of dread, because it invariably turns into an ear infection. Tubes have been a real life-saver with my kids and, as a mom, I highly recommend them as a way to combat persistent ear infections.

 

 

 

 

8 responses so far

  • Dr. Sneetch says:

    Oh the poor little dear. I hope everything goes smoothly.

    I had sinus surgery too. It didn't work for me and I ended up taking a lot of antibiotics. Stress and extremely cold weather sets it off (among many other things).

    My kids have varying combinations of sinus and asthma and ear infections just like me. Sigh. Wish they had taken after spouse who has a stronger contitituion - those hardy German genes would have come in handy. But the good news is they do outgrow it when they get older.

    • GMP says:

      My kids have varying combinations of sinus and asthma and ear infections just like me.

      I hear ya. My eldest has asthma.

      I am forever complaining about the weather here. Love the university, hate the endless winters.

  • Namnezia says:

    I never understood how the tubes don't distort your hearing.

    Hope all goes smoothly.

    • GMP says:

      I never understood how the tubes don't distort your hearing.

      I'm not a doctor, but I can offer you an explanation as I see it based on physics.

      The oscillation of the eardrum with a tube versus without a tube in response to a sound wave (essentially a pressure or density wave in the air) is probably slightly different -- different net eardrum mass plus a hole/no hole. But, tubes seem to be placed very low in the eardrum, so my guess is that from the oscillation standpoint (as sound wavefront hits upper part of eardrum first) the existence of a hole has little bearing. Then the difference in the eardrum response comes down to the difference in mass between eardrum with tube and without; my guess it the difference is very small (I think the tube is a couple of mm in diameter).

      However, even with a slight difference in the response to the sound wave that tube insertion brings, what you get is a vast improvement in hearing when compared to the case of persistent fluid or pus in the middle ear, where the eardrum cannot move at all. So tubes offer a big improvement in eardrum mobility and keep air (and not fluid, which can get very thick) in the middle ear. (There are also other scary things, such as damage to the tiny bones in the middle ear and to the organs of the inner ear that can come about with untreated or prolonged ear infections, and tubes prevent these...)

      This is how I see it. Obviously, if there is a pediatrician around (Matthew?) I am sure we can get a more precise and detailed account.

  • Scicurious says:

    I admit that when I saw the title of this post and the first sentence, my first thought was "she and her husband like the same type of Eppendorf tube? That's so cute!" I'm a nerd.

    Hope the procedure goes well!

  • rs says:

    Good luck. Hope everything goes well. Not sure if my experiance is useful in this case, but anyway i might be useful to someone else.

    my daughter had a series cold in her second winter (in a cold country) when she started daycare close to year and half in age and things were so bad that we were continuosly on antibiotics. She used to through up every night and it was a nightmare. Then we happened to go to Israel and as soon as she sat foot on warm country, she started to to imrpove and in a week, she was completely recovered and never had that bad infections again (now she is 7&1/2).

    Now when you are well settled, maybe moving to warmer place might help everyone with their infections/problems.

  • Matthew says:

    Myringotomy tubes can vastly improve the quality of life for little children prone to ear infections. I think you hit on most of the real high points here- less antibiotic use being a big one. Typically, pediatricians use six ear infections in one year or one persistent one (greater than three months) as a cut off for referring children to ENT for tubes but I put a lot of weight on family history.

    The tubes themselves are pretty safe and have no effect on hearing. The real consideration is the use of anesthesia. This is a real risk and should be taken seriously but, in a child who is suffering from multiple ear infections, the benefits really far outweigh the risks. Hope this is the last of the ear infections for your little one!