Transcription:
Ear Tubes: Everything a Parent Needs to Know

Bill Klaproth (Host): Ear infections are one of the most common medical issues for babies and toddlers. In fact, most young children between the ages of six months to three years old will suffer from ear infections at some point. It can be a frustrating cycle for parents before it's recommended that your child get ear tubes. Tubes are a temporary, but effective way to relieve your child's pain and discomfort. So, let's talk with Dr. Anthony Sheyn, Division Chief of Pediatric Otolaryngology at Le Bonheur Children's Hospital, who is here to help parents understand everything they need to know about ear tubes.

This is the Peds Pod by Le Bonheur Children's hospital. I'm Bill Klaproth. Dr. Sheyn, as always, great to talk with you. Thank you so much for your time. This is a big topic. So excited to talk about this because I know there's probably a lot of parents that have these questions. So to start and to help parents better understand ear infections and the need for tubes, could you explain what leads to ear infections?

Dr. Anthony Sheyn: Yeah. Great to be back here. And ear infections are kind of a product of a couple of factors. One factor is age and anatomy. The ear is actually the organ that's the closest to the adult form when the child is born, that's about 80% formed. But even so, it still has a very short approximation and anytime you get any kind of virus, it can stay there and cause fluid, which can turn into a bacterial infection, which is the basis for how they form. And there are certain factors that children experience that adults really don't that caused them to have more ear infections than adults.

Two largest factors that can contribute to ear infections are being in daycare, children who are in daycare are over two and a half times more likely to develop ear infections than those who aren't. That's just because they've not been exposed to other children and their immune systems are ramping up. So, they're going to spread a little bugs from child to child when they're in daycare.

And then, the second most common factor is a family history and it has been shown that children who have siblings, who have had ear tubes, not just ear infections, but ear infection severe enough to require ear tubes are twice as likely to develop ear infections requiring ear tubes themselves. And then as the further you get away from relation, the further the risk factor goes down. For example, having parents who had ear infections with ear tubes increases your risk by one and a half, grandparents one and a quarter, and then cousins, more distant relatives, that just decreases. But there is heredity to getting ear tubes as well as getting ear infections.

And then, there are the more well known factors, which are not major, but still contribute, such as secondhand smoke exposure, using a bottle when you're laying flat in the crib that's why we advise parents never to put their babies down to sleep with a bottle, and using a pacifier. So quitting a pacifier is much like quitting smoking. You can't force somebody to do it. And know when they're ready, they'll give it up.

Bill Klaproth (Host): That's really interesting. I never knew those things. Sleeping with a bottle, that just makes sense. Secondhand smoke, would have never thought that, and then a pacifier as well. So, you add in kids' age, right? And if they go to daycare and maybe a family member has a history or brother or sister and pretty good chance is you're going to wind up with ear infections.

Dr. Anthony Sheyn: Ear infections and then proceed to ear tubes.

Bill Klaproth (Host): Yeah. So, let's talk about that. What leads then to the decision to recommend a child get ear tubes?

Dr. Anthony Sheyn: So, there are really two guidelines that we follow in terms of when a child needs ear tubes. The first, one of the most common one, is three or more ear infections in a six-month period with an abnormal hearing test, that generally requires ear tubes. And the second most common is having ear fluid or middle ear fluid for three months or longer, which can impact their ability to hear and develop language. If the fluid does not go away within three months, then we would recommend putting ear tubes to drain it and to prevent any further accumulations, regardless of how many ear infections.

Bill Klaproth (Host): So then, can you talk us through what the typical ear tube procedure is like?

Dr. Anthony Sheyn: It's actually the most common procedure in the world. Generally, it takes about three minutes to perform. You actually don't even need anesthesia. In adults, we frequently do this in the office. You make a little incision in the eardrum. If there is any fluid, you suck it out. And then, you put the tube in and then you send the patients home often with some eardrops if they have any fluid or any ear infection to get rid of the rest of it. And we actually have started doing this here on kids awake without anesthesia. We use a little device that's called a Hummingbird, that's just the name of the device. And it pierces the eardrum, deploys the tube, we suck fluid out. That's about three minutes in the office. There is a little bit of screaming involved, but not necessarily because of pain, more because of the child, it's a baby and they don't really want anybody messing with them and they don't really realize what's happening to them. So, they would cry just as much, even if we were just looking in their ears.

Bill Klaproth (Host): Sure. So, what does the tube do then? Does it help the drainage?

Dr. Anthony Sheyn: So, it's actually called a ventilation tube and it does exactly that. It helps to improve the ventilation of the middle ear, which is a very small space in the child. So, it equalizes the pressure between the inside and the outside. And by doing so, it hopefully decreases how many ear infections a child has. That's not going to stop them completely, but it will allow us to put eardrops in, which are a thousand times more powerful than the oral antibiotics, if a child gets future ear infections after the tubes are actually in place.

Bill Klaproth (Host): Right. And your clinic has a new way of doing the procedure. Is that what you were just talking about, using the Hummingbird and easily piercing the eardrum? Can you tell us more about that?

Dr. Anthony Sheyn: So, it's very similar, except it's just one motion. Instead of making a cut in the eardrum, we pierce the eardrum, the ear tube is within the device. And then, we deploy the ear tube. And then, we're done. It takes longer to clear the ear wax out than it does to actually put the tube in.

Bill Klaproth (Host): So, that's why it's so quick. It deploys the little tube at the same time your piercing the eardrum, pull it out and, basically, you're done.

Dr. Anthony Sheyn: And it's quick. Parents like it because their children don't have to be hungry. They don't need to wait for anesthesia to wear off after the procedure. Theoretically, they can eat as I'm doing it, but they don't, but they can eat immediately before and immediately after. And generally, the crying stops as soon as they're back in their parents' arms.

Bill Klaproth (Host): Okay. So then, what is the recovery process like? It sounds like it's fairly easy. And then, how long do those tubes last?

Dr. Anthony Sheyn: Recovery from anesthesia is just related to anesthesia. Kids are hopping and skipping out of the recovery room 30 minutes after they wake up. Recovery in the office is immediate. There are no restrictions. We don't even recommend putting ear plugs in the ears to keep water out because that has not been shown to make any kind of difference. So, kids can continue to swim. We're okay or most of us are okay with getting water in the ears. And they usually last about six to 18 months. Although they can last longer, but there is quite a bit of evidence if they stay in longer than two years after age five, then they should be removed.

Bill Klaproth (Host): And is that something you go back to the doctor to have them removed or do they fall out on their own? How does that work?

Dr. Anthony Sheyn: The majority of the time they fall out on their own and they don't need to be removed. But if they're still in beyond age five for over two years, then we do take them out under sedation.

Bill Klaproth (Host): I know you said this is one of the most common procedures in the world. Are there any alternative forms of treatment that you recommend?

Dr. Anthony Sheyn: There really aren't. If a child has normal speech development and their hearing is normal, despite the frequency of ear infections, it is often an option to observe. Really, we put tubes in and treat kids for ear infections. It's mostly to help their speech development. If their speech is not developing, if they're delayed, then I would certainly recommend ear tubes to prevent ear infections that prevent that hearing loss that can happen when you have an ear infection or if there's fluid in the ear. But there is no medication that'll make ear fluid go away. There really is no alternative to minimizing the risk factors except for taking the child out of daycare, which is not necessarily a correctable risk factor for a lot of families.

Bill Klaproth (Host): So since tubes are a temporary solution, when do ear infections become less likely to occur for young children?

Dr. Anthony Sheyn: In most kids, they become less likely by between ages five and seven when the anatomy starts really taken on the adult configuration.

Bill Klaproth (Host): By that time, generally, they're out of daycare as well. No more sleeping with a bottle. All those other things kind of disappear as well, right?

Dr. Anthony Sheyn: Ideally, yes.

Bill Klaproth (Host): So when it comes to ear tubes, any final thoughts on this, Dr. Sheyn, for a parent that's listening to this right now?

Dr. Anthony Sheyn: Well, actually, yes, there is quite a bit of difference between when our specialty would recommend ear tubes and when the pediatricians would recommend ear tubes. So, we focus more on a six-month period with less ear infections, but we want to see them consistently. In the current pediatric guidelines, say six or more ear infections in a 12-month period, well, if you've had six ear infections during the first six months and not during the last six months, then to us, you don't really need ear tubes. And ear tubes also don't hurt. They don't really change the lifestyle anymore like they did in the past because you can get water in your ear and you can go about taking swimming lessons and bathing and not fighting with your children about putting plugs in.

Bill Klaproth (Host): Yeah. For new parents, how do they recognize an ear infection? Is it just simply the child is kind of tugging at their ears and crying? How does a new parent know that?

Dr. Anthony Sheyn: So, that's often a symptom that's also a symptom of teething. So, ear infections are very often associated with ear pain, so ear tugging, headshaking, banging your head up against the pillow or your mattress. There's almost always a fever and is often present in the setting of an upper respiratory infection. Like I tell the parents, an ear infection is just a symptom of an upper respiratory infection. It's not the cause of all these other symptoms of runny nose.

Bill Klaproth (Host): Okay. So, stuffy nose, runny nose, and the child has that and the other symptoms, like you said, but you know, head banging on the pillow, tugging ear, that's a pretty good indication and time to go see the doctor. Is that right?

Dr. Anthony Sheyn: Right.

Bill Klaproth (Host): Absolutely. Well, this has been fascinating. As you said, one of the most common procedures, but a lot of kids get this. So, there's a lot of interest in this and a lot of questions to be asked and answered. And you've done just that for us, Dr. Sheyn. So, thank you so much for your time. We really appreciate it.

Dr. Anthony Sheyn: Thank you for having me. Have a great day.

Bill Klaproth (Host): And once again, that's Dr. Anthony Sheyn, and you can visit lebonheur.org to learn more about Lebonheur Children's Hospital. And be sure to subscribe to The Peds Pod on Apple Podcasts, Google Podcasts, or wherever you listen to your podcast. You can also check out lebonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels.

This is The Peds Pod by Lebonheur Children's Hospital. Thanks for listening.