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Tubes can help restore hearing in children with recurrent ear infections

DEAR DR.PAUL: My 18-month-old son is about to have tubes put into his ears because of persistent ear infections. Any information you have would help considerably. He had a hearing test and has a 30% loss in the affected ear. Will this return to normal after the tubes are inserted?

PEDIATRICIAN DR.PAUL Answers: Your question reminds me of a family that called me recently in a panic as they were told, just like you, that their two-year-old son had a hearing loss related to recurrent ear infections. I explained to them that one of the most common complications of ear infections is the persistence of fluid in the middle ear. The middle ear is the area behind the eardrum, the area in which sound is transmitted.

Normally there is no fluid in this space. In most people the Eustachian tube, a connection between the middle ear space and the nose, drains any fluid build-up, keeping the space dry or empty.

However, in children the Eustachian tube does not work very well, and this can result in build-up of fluid after an ear infection. With recurrent ear infections, fluid in the middle ear is always present, blocking or muffling sound transmission resulting in a "conductive hearing loss".

Most children with fluid in the middle ear space are also less than three years of age and still developing their speech. Of course, proper hearing is essential for speech to develop normally. This is why we need to do something about young children who have a hearing loss associated with the fluid in the middle ear in order to assure their normal speech development. Antibiotics or other medications will not get rid of the fluid. The only possible way to help these children regain normal hearing is to insert tubes into the eardrum. Under general anesthesia, the Ear-Nose-Throat (ENT) surgeon cuts a tiny hole in the eardrum and inserts a small tube called a PE tube. The PE tube drains the middle ear space allowing sound to be transmitted. Usually, hearing is fully restored to normal levels.

In older, co-operative children this can be done under local anaesthetic. In North America, PE tube insertion is the most common surgical procedure in children, and aside from the usual minimal risks of anesthesia, there really are no complications or other risks.

After I explained this to the parents, they were relieved and the child had the tubes inserted. In follow-up visits they happily noted how much better their son could hear and how much more quickly his speech was developing. Their question then was: "What happens to the tubes?" In most children the tubes fall out by themselves within a year of insertion. There is no need for another surgical procedure to remove them.

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