Consider ear tubes if fluid has stayed put for at least 3 months.
Don't assume a suddenly inattentive child has developed selective hearing -- it could be muffled hearing. The same goes for a kid who begins talking more loudly. Even if there are no signs of ear pain, like irritability or sleeplessness, see your pediatrician, who can check for fluid in the middle ear and perhaps refer you to an ear, nose, and throat specialist (called an otolaryngologist or ENT). Then sit tight. By three months, 90 percent of fluid resolves on its own. In the meantime, let teachers and caregivers know your child's hearing may be impaired for a while.
Fluid that remains longer than three months might be there to stay and can affect language skills, a situation that may call for tympanostomy tubes. Tiny and inserted into the eardrum, these allow air to flow in and fluid to flow out; they usually fall out naturally after about 14 months. The procedure is so common that parents often refer casually to kids "getting tubes" -- but it requires surgery and carries all the usual drawbacks, including anesthesia risks. The American Academy of Pediatrics and the American Academy of Otolaryngology Head and Neck Surgery recommend reserving tubes for fluid that hasn't budged for three or four months straight.
In a recent study, however, researchers found that 75 percent of 682 kids who received ear tubes in New York City hospitals had fluid for less than a month and a half. "This is much earlier than experts deem necessary," says study author Salomeh Keyhani, MD, assistant professor of health policy at Mount Sinai School of Medicine. "The risks and benefits should be balanced. If the child could get better on her own, why do surgery?" Dr. Keyhani speculates that parents take a pediatrician's referral to an ENT as mandate for surgery. Be sure to discuss the necessity of tubes with all doctors involved.