While it's too early to tell, "anecdotally it does seem to have made a difference," said Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y. He chaired the task force that drew up the guidelines.
The guidelines state that for children with recurrent ear infections, ear tubes, or tympanostomy tubes, should be put in place only if middle-ear fluid is also present in at least one ear at the time of inspection. Children with persistent fluid buildup in the middle ear of both ears for at least three months, with or without an ear infection, are also candidates for ear-tube surgery.
Previously many doctors recommended ear tubes in children who either had recurrent ear infections—three in six months or four in a year—without fluid, or middle-ear effusion. Ear infections are concerning because of potential hearing loss that could cause developmental delays.
Contributing to a desire by doctors and parents to avoid surgery are concerns about the use of general anesthesia in young children. Researchers and doctors are exploring devices that would enable ear-tube procedures to be performed using alternatives. Preceptis Medical, a Plymouth, Minn., company, is testing a device, the Hummingbird, that uses nitrous oxide instead of general anesthesia in clinical trials at four sites, including the Mayo Clinic. Acclarent, a division of Johnson & Johnson, is working on using technologies that may allow for ear-tube procedures to be done in-office without general anesthesia, a spokeswoman said.
To insert tubes, doctors make a small cut in the eardrum and place the tiny, cylinder-like tube through it. It takes less than 10 minutes. The tube helps with air flow and prevents the buildup of fluids behind the eardrum. The tubes usually fall out within a year or two, and the holes close on their own, though sometimes a doctor must close them surgically. Children with tubes can still get ear infections, but doctors say they are generally less frequent, milder and can be treated with antibiotic drops.
Image: Ear exam, via Shutterstock