Selected Podcast
Kids & Ear Tubes
Some children require ear tubes to reduce frequency of infections. Dr. Michael Ferguson, Director of WakeMed Physician Practices ENT, Head & Neck Surgery Program, discusses how ear tubes work and when they are recommended.
Featured Speaker:
Learn more about Michael Ferguson, MD
Michael Ferguson, MD
Dr. Michael Ferguson is an expert ear nose and throat doctor, with clinical interests ranging from pediatric ear nose and throat (ENT), sinus disease, thyroid surgery and cancers of the head and neck. He loves helping his ear, nose and throat patients of all ages and is also an excellent teacher, and is the recipient of the Kaiser Permanente Excellence in Teaching Award. He is the director of WakeMed Physician Practices' ENT, Head and Neck Surgery Program.Learn more about Michael Ferguson, MD
Transcription:
Kids & Ear Tubes
Prakash Chandran (Host): Ear tubes are often considered a last resort when it comes to treating ear infections. But they are actually more common than you might realize. Let’s talk with Dr. Michael Ferguson, Director of Ear, Nose and Throat Surgery at WakeMed Health and Hospitals. This is WakeMed Voices, the Podcast from WakeMed Health and Hospitals. I’m Prakash Chandran. So, Dr. Ferguson, let’s start with the basics. What causes an ear infection?
Michael Ferguson, MD (Guest): So, the simplest way to begin the conversation is ear infections are an inflammation of the lining inside the area behind the eardrum called the middle ear and they can get an inflammation. It can either be caused by a bacteria. It can be caused by a virus. The most simple thing is that a kid will get a bad cold and they will get an upper respiratory infection of some sort, and all of that will potentially track into the ears and can cause an ear infection.
Host: So, how about for those worse case scenarios where you are giving the child a round of antibiotics, they don’t seem to be working. I have heard of ear tubes. I have no idea what they are. Maybe you can explain that for our audience.
Dr. Ferguson: Great. Yeah, so ear tubes are kind of where the – it’s the ear, nose and throat sweet spot when we have kids that are coming into see us. They are basically coming in because they have one of a few different scenarios. They either have had multiple ear infections that continue to happen. We generally diagnose – or we generally classify recurring ear infections as kids that have three or more infections in a six month period or four or more infections in a one year period. And so those kids will usually make their way to us or the kids that no matter what you do, the ear infection isn’t getting better. And that’s when you begin to say okay, well we can keep slamming our knuckles in a draw with the same treatment over and over again, or we can say is there something different we can do.
And ear tubes is the definition of something different we can do. And essentially, the big problem is is that the normal way that we ventilate that space called the middle ear behind our eardrum, the normal way that we ventilate it oftentimes just doesn’t work very well with kids. And so, you have this space behind the eardrum which is constantly under negative pressure and that negative pressure keeps basically sucking in fluid, it sucks in bacteria or viruses from the back of the nose. You treat it with antibiotics, but it is just wash, rinse, repeat. As soon as it gets better, you have just sort of gone backwards to the same problem you had before.
So, the concept of ear tubes is it’s a way to ventilate or to artificially ventilate that space so that that negative pressure can’t build up. It essentially says the eustachian tube isn’t doing it’s job, can we put in a basically an artificial ventilation port so that that negative pressure doesn’t build up and so that that infection is less likely to happen. I always describe to parents, if I handed you a vacuum sealed jar of olives and I said how in the world are you going to break the seal on this jar. Well everybody knows the answer to that question. You are either going to open the lid of the jar or even if you just take a can opener and put a hole in the lid of the jar; that is going to break that vacuum seal and that fluid is going to come out of that jar.
The middle ear and the eardrum of a kid is basically like a little miniature jar that I want to put a hole in the lid of. And that’s what an ear tube does.
Host: Got it. That makes a lot of sense. And does the ear tube actually stay in the child’s ear through adulthood or is it something that gets removed over time?
Dr. Ferguson: It’s something that actually comes out naturally over time. So, when tubes are put in, it is a surgery that we do under what’s basically a very light general anesthesia, so we don’t have to put IVs in kids. we don’t have to put breathing tubes, but we do have to take them to the operating room and essentially we look at their ears under a microscope, we make a little slit in the eardrum drain the fluid out and then we have a very, very small tube that looks almost like a little spool that goes into the eardrum and sits there and that serves as our little ventilation port.
The eardrum doesn’t like it and so the minute you put it in, the eardrum wants to push it out. So, the eardrum is a membrane and it will naturally grow behind the tube and push it into the ear canal. That usually happens with the basic tubes that we use, it usually happens over about nine months to a year. So, what happens is, is we basically – we put the ear tubes in and then they will stay in typically for that time period and then once they come out; the hope is is that the child has then had some maturation or growing up of their eustachian tube and when the tubes come out, and we are sort of expecting the eustachian tube to function again; we are hopeful that that has had a year or so of growth and will function more normally. It will be less likely to create that environment that causes ear infections.
Host: So, Dr. Ferguson, tell me a little bit about how common ear tubes are.
Dr. Ferguson: Ear tubes are super common. If you look at procedures that are done on kids in the United States; it’s by far the most common procedure that we see done. There’s about somewhere in the neighborhood of 670,000 kids that will get ear tubes every year. So, about one in fifteen kids are going to get ear tubes. So, in your daycare or in your school class, one or two kids in that class will have ear tubes for sure.
Host: So, hear that parents. Do not get freaked out at all if your kids needs ear tubes. It sounds like it’s very common. And one thing in closing here that I always like to talk about is prevention. We’ve been talking about these worse case scenarios where there’s a round of antibiotics then there’s the ear tube option, which is great to know about; but let’s talk about if a parent wants to prevent their child from getting ear infections, what can they do?
Dr. Ferguson: They can put them in a glass bubble somewhere and just leave them there until they are three years old and then they can let them out and start playing with other kids. No. The basic principles behind it is what you already know. I mean just kids washing their hands and not trying to wipe their noses on other people’s clothes as much as possible is the obvious – the way to prevent it. But we are humans and we are going to interact, and we are going to share germs and there is no way to prevent that. The hope is that your kid is one of those kids that has an nicely normally functioning eustachian tube and you don’t really run into this problem of recurring ear infections.
But if you do, for us, we feel like the kids that continue to have problems, ear tubes are a really lifesaving or life-altering solution for families because you go from having this kid that’s miserable all the time to essentially in a pretty quick simple not a five minute procedure, you almost can prevent the vast majority of the infections ever happening again. And then the other thing is probably worth mentioning is ear tubes also add a separate benefit for kids that have them in that it’s not just about preventing, it’s about an easier way to diagnose and treat. You remember I said kind of at the beginning of this talk that we have scenarios where it’s really hard to know if a kid has an ear infection. Well, when they have an ear tube, they now have a little pipe in their ear and if they get an ear infection; it will drain out and you’ll see the infection and moms and dads can know their kid has an infection and instead of always having to go straight to oral antibiotics; we can treat with topical local ear drops. So, no systemic oral antibiotics, less frequent. So, in the right kid, with recurring disease, it’s a total win.
Host: All right Dr. Ferguson. I really appreciate your time today. That’s Dr. Michael Ferguson, the Director of Ear, Nose and Throat Surgery at WakeMed Health and Hospitals. Thanks for checking out this episode of WakeMed Voices. Head on over to www.wakemed.org to get connected with Dr. Ferguson or another provider. If you found this podcast helpful, please share it on your social channels. That would really help us out. And be sure to check out the entire podcast library for topics of interest to you. See you next time.
Kids & Ear Tubes
Prakash Chandran (Host): Ear tubes are often considered a last resort when it comes to treating ear infections. But they are actually more common than you might realize. Let’s talk with Dr. Michael Ferguson, Director of Ear, Nose and Throat Surgery at WakeMed Health and Hospitals. This is WakeMed Voices, the Podcast from WakeMed Health and Hospitals. I’m Prakash Chandran. So, Dr. Ferguson, let’s start with the basics. What causes an ear infection?
Michael Ferguson, MD (Guest): So, the simplest way to begin the conversation is ear infections are an inflammation of the lining inside the area behind the eardrum called the middle ear and they can get an inflammation. It can either be caused by a bacteria. It can be caused by a virus. The most simple thing is that a kid will get a bad cold and they will get an upper respiratory infection of some sort, and all of that will potentially track into the ears and can cause an ear infection.
Host: So, how about for those worse case scenarios where you are giving the child a round of antibiotics, they don’t seem to be working. I have heard of ear tubes. I have no idea what they are. Maybe you can explain that for our audience.
Dr. Ferguson: Great. Yeah, so ear tubes are kind of where the – it’s the ear, nose and throat sweet spot when we have kids that are coming into see us. They are basically coming in because they have one of a few different scenarios. They either have had multiple ear infections that continue to happen. We generally diagnose – or we generally classify recurring ear infections as kids that have three or more infections in a six month period or four or more infections in a one year period. And so those kids will usually make their way to us or the kids that no matter what you do, the ear infection isn’t getting better. And that’s when you begin to say okay, well we can keep slamming our knuckles in a draw with the same treatment over and over again, or we can say is there something different we can do.
And ear tubes is the definition of something different we can do. And essentially, the big problem is is that the normal way that we ventilate that space called the middle ear behind our eardrum, the normal way that we ventilate it oftentimes just doesn’t work very well with kids. And so, you have this space behind the eardrum which is constantly under negative pressure and that negative pressure keeps basically sucking in fluid, it sucks in bacteria or viruses from the back of the nose. You treat it with antibiotics, but it is just wash, rinse, repeat. As soon as it gets better, you have just sort of gone backwards to the same problem you had before.
So, the concept of ear tubes is it’s a way to ventilate or to artificially ventilate that space so that that negative pressure can’t build up. It essentially says the eustachian tube isn’t doing it’s job, can we put in a basically an artificial ventilation port so that that negative pressure doesn’t build up and so that that infection is less likely to happen. I always describe to parents, if I handed you a vacuum sealed jar of olives and I said how in the world are you going to break the seal on this jar. Well everybody knows the answer to that question. You are either going to open the lid of the jar or even if you just take a can opener and put a hole in the lid of the jar; that is going to break that vacuum seal and that fluid is going to come out of that jar.
The middle ear and the eardrum of a kid is basically like a little miniature jar that I want to put a hole in the lid of. And that’s what an ear tube does.
Host: Got it. That makes a lot of sense. And does the ear tube actually stay in the child’s ear through adulthood or is it something that gets removed over time?
Dr. Ferguson: It’s something that actually comes out naturally over time. So, when tubes are put in, it is a surgery that we do under what’s basically a very light general anesthesia, so we don’t have to put IVs in kids. we don’t have to put breathing tubes, but we do have to take them to the operating room and essentially we look at their ears under a microscope, we make a little slit in the eardrum drain the fluid out and then we have a very, very small tube that looks almost like a little spool that goes into the eardrum and sits there and that serves as our little ventilation port.
The eardrum doesn’t like it and so the minute you put it in, the eardrum wants to push it out. So, the eardrum is a membrane and it will naturally grow behind the tube and push it into the ear canal. That usually happens with the basic tubes that we use, it usually happens over about nine months to a year. So, what happens is, is we basically – we put the ear tubes in and then they will stay in typically for that time period and then once they come out; the hope is is that the child has then had some maturation or growing up of their eustachian tube and when the tubes come out, and we are sort of expecting the eustachian tube to function again; we are hopeful that that has had a year or so of growth and will function more normally. It will be less likely to create that environment that causes ear infections.
Host: So, Dr. Ferguson, tell me a little bit about how common ear tubes are.
Dr. Ferguson: Ear tubes are super common. If you look at procedures that are done on kids in the United States; it’s by far the most common procedure that we see done. There’s about somewhere in the neighborhood of 670,000 kids that will get ear tubes every year. So, about one in fifteen kids are going to get ear tubes. So, in your daycare or in your school class, one or two kids in that class will have ear tubes for sure.
Host: So, hear that parents. Do not get freaked out at all if your kids needs ear tubes. It sounds like it’s very common. And one thing in closing here that I always like to talk about is prevention. We’ve been talking about these worse case scenarios where there’s a round of antibiotics then there’s the ear tube option, which is great to know about; but let’s talk about if a parent wants to prevent their child from getting ear infections, what can they do?
Dr. Ferguson: They can put them in a glass bubble somewhere and just leave them there until they are three years old and then they can let them out and start playing with other kids. No. The basic principles behind it is what you already know. I mean just kids washing their hands and not trying to wipe their noses on other people’s clothes as much as possible is the obvious – the way to prevent it. But we are humans and we are going to interact, and we are going to share germs and there is no way to prevent that. The hope is that your kid is one of those kids that has an nicely normally functioning eustachian tube and you don’t really run into this problem of recurring ear infections.
But if you do, for us, we feel like the kids that continue to have problems, ear tubes are a really lifesaving or life-altering solution for families because you go from having this kid that’s miserable all the time to essentially in a pretty quick simple not a five minute procedure, you almost can prevent the vast majority of the infections ever happening again. And then the other thing is probably worth mentioning is ear tubes also add a separate benefit for kids that have them in that it’s not just about preventing, it’s about an easier way to diagnose and treat. You remember I said kind of at the beginning of this talk that we have scenarios where it’s really hard to know if a kid has an ear infection. Well, when they have an ear tube, they now have a little pipe in their ear and if they get an ear infection; it will drain out and you’ll see the infection and moms and dads can know their kid has an infection and instead of always having to go straight to oral antibiotics; we can treat with topical local ear drops. So, no systemic oral antibiotics, less frequent. So, in the right kid, with recurring disease, it’s a total win.
Host: All right Dr. Ferguson. I really appreciate your time today. That’s Dr. Michael Ferguson, the Director of Ear, Nose and Throat Surgery at WakeMed Health and Hospitals. Thanks for checking out this episode of WakeMed Voices. Head on over to www.wakemed.org to get connected with Dr. Ferguson or another provider. If you found this podcast helpful, please share it on your social channels. That would really help us out. And be sure to check out the entire podcast library for topics of interest to you. See you next time.