Amanda Wilde (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. Ear tubes can improve ear health, hearing, and development in children. Pediatric otolaryngologist Dr. Cynthia Wang discusses what ear tubes are, why a child might need them, and what parents should know.

I'm Amanda Wilde. Dr. Wang, thank you so much for being here.

Dr. Cynthia Wang: Thank you so much. It's such an honor to be here.

Host: Well, it's wonderful to have an expert. Maybe you should explain quickly what an otolaryngologist is.

Dr. Cynthia Wang: Otolaryngology is the official medical term for our specialty, but we're also known as ear, nose and throat specialists. I am a pediatric ENT doctor or otolaryngologist, and we specialize in disorders that involve the ear, nose, and throat.

Host: Do you see a lot of kids that do need ear tubes?

Dr. Cynthia Wang: We certainly do. It's one of the most common consultations we see in our clinics. And it's also one of the most common elective procedures performed in children.

Host: So, what are ear tubes? What do they actually do?

Dr. Cynthia Wang: So, ear tubes are basically these small, either silicone or plastic tubes that we insert into the eardrum. They are about two millimeters in size. They're very small and they help ventilate the space behind the eardrum. And that space is called the middle ear. So, it helps drain and prevent any fluid from building up behind the eardrum.

Host: And what are some of the most common reasons a child might need ear tubes? You just gave a hint there that fluid builds up. I know infections are a big part of what leads to ear tubes, but can you give us a broader look at that?

Dr. Cynthia Wang: Yeah. So, the most common reason for ear tubes is most likely recurrent ear infections. Other reasons would include persistent fluid behind the eardrum that could lead to hearing difficulties or, in some rare instances, we place ear tubes for severe ear infections that persist despite antibiotics or ear infections that require more invasive interventions like surgery.

Host: Are recurrent ear infections the main reason you end up doing tubes for your patients?

Dr. Cynthia Wang: Yes. That is probably the most common reason we offer ear tubes is for recurrent ear infections.

Host: I'm asking because how many ear infections are considered too many? They are so common with young children.

Dr. Cynthia Wang: Yeah. That's a really great question. So, ear infections in children is common. We usually recommend ear tubes in kids who have had three or more ear infections in the past six months, or four or more in the past 12 months.

Host: Are there signs parents might notice at home that suggest fluid buildup or hearing issues, the other reasons that children might be candidates for ear tubes?

Dr. Cynthia Wang: Yes. So, there are some common symptoms that parents may notice. Most of these symptoms are signs that their child isn't hearing very well. So, either their child is turning up the volume on their TV or tablet, or they're not responding when talked to at a normal volume or when called at a normal volume.

 Sometimes we also see delays in speech development or articulation issues. That is also something we see where the kid isn't having a lot of ear infections, but we test their hearing and we notice that there is fluid behind the eardrum, and also some hearing difficulties. Some other signs of fluid behind the eardrum could also very rarely, but It can be seen as some balance issues. So if fluid is retained behind the eardrum, it can sometimes affect a child's balance. And some parents may notice some difficulty with kind of just falling over when walking and things like that.

Host: Those are really good things to keep in mind because we could sometimes assign those issues to other causes. So, it's a good reminder that even in a noisy world, a child not responding, not seeming to hear normally, possibly balance issues and delays in speech development, well, it could be caused by fluid buildup, right?

Dr. Cynthia Wang: Exactly. Yes.

Host: Yeah. What does the ear tube procedure involve? And how long does recovery typically take?

Dr. Cynthia Wang: So, the ear tube procedure is done typically under general anesthesia. The procedure itself takes about five to 10 minutes. So, it's fairly quick, and recovery is usually just a day. So, most kids are back to their normal selves usually by the next day and can go back-to-school or daycare afterwards.

Usually, recovery-wise, there's not much in terms of care or maintenance that parents need to do past the 24 hours. We often will prescribe some sort of eardrops afterwards. It's usually for about a week or so that parents have to administer. But that is really about it. After the eardrops are done, most parents don't need to do anything else to help with recovery.

Host: So, that sounds very minimally invasive.

Dr. Cynthia Wang: It's pretty well-tolerated by kids, and it helps a lot with ear infections and ear discomfort. We are starting to offer an alternative to the ear tube surgery, where the ear tubes are actually placed in office without general anesthesia. This is a relatively new type of procedure and it does require a certain type of child to be able to sit still for this procedure. But it does remove that requirement for general anesthesia. And what we do is it's basically a quick five-minute procedure, where we numb the eardrum and then we place the ear tube that day in the office. But I would definitely recommend a consultation with an ENT to make sure that your kid is a good candidate for this type of ear tube, just because it does require for kids to be able to sit still for it.

Host: Well, what do you see in terms of success? And how do you measure that success?

Dr. Cynthia Wang: Really, just the frequency of ear infections, and also improvement in hearing. We typically have our patients come back about three to four months after surgery to retest their hearing and also to reexamine the ear. Most parents report that their frequency of ear infections do decrease after surgery.

One thing to also note is that it is possible to get ear infections while the ear tubes are in, but the ear tubes do give an added benefit that it allows us direct access to the site of infection and instead of having to give antibiotics by mouth to treat these infections, once the ear tubes are in, if there is an infection, this can often be treated with antibiotic eardrops instead of having to give antibiotics by mouth.

Host: Do ear tubes affect a child's speech or development or hearing in the long- term?

Dr. Cynthia Wang: So, I would say that ear tubes, while they are in the eardrum, do help with a child's hearing and development. I don't know if I mentioned this previously, but the ear tubes are temporary, so they do fall out after about six months to a year. Usually, that happens naturally and parents usually don't notice it when they do fall out. The hope is that by that time when the tubes have fallen out, the kid has developed their own ability to drain that fluid and also prevent ear infections just with the passage of time.

But while the tubes are in, it certainly will help with hearing and speech development for sure because the child isn't getting ear infections as frequently, so it's not impacting their hearing while they are being treated for infections.

Host: This sounds like it might be the best solution to those recurring ear infections, but are there alternatives to ear tubes or situations where doctors prefer to wait and monitor?

Dr. Cynthia Wang: There certainly are situations where we wouldn't proceed directly to surgery. First of all is if the frequency of ear infections is not high enough, so if it doesn't meet the criteria of three or more in six months or four or more in a year, especially if you know your kid is not having any issues with hearing or speech, it would be reasonable to wait, especially if parents are nervous about surgery that is a conversation to be had with your doctor, your ENT doctor, whether to wait or not. Especially if there's no fluid in the ears or no abnormality and hearing on the day that we see you in clinic, it is certainly reasonable to wait in those situations.

And there are situations where we would recommend surgery, and that would be where if your child is having signs of speech delay or if your child is at risk for a developmental delay. So there are certain conditions like Trisomy 21 or kids with cleft lip or cleft palate where they are already at a high-risk for speech and language difficulties where I would recommend more strongly for their child to get ear tubes.

Host: So, it really depends on each individual situation.

Dr. Cynthia Wang: Definitely.

Amanda Wilde (Host): Thank you for sharing your expertise and helping us understand the function of ear tubes.

Dr. Cynthia Wang: Yeah, you're welcome.

Host: For more information, visit childrens.com/ent. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode, and please follow Children's Health on your social channels.