Ear tubes can help infections, but not language development

Q.

My child has had many ear infections, and I am worried that he will fall behind in his language skills. Someone suggested ear tubes for him, but I am concerned about surgery. Is it necessary?

A.

For much of my career in pediatrics, we have been concerned about language development in kids with lots of ear infections.

Ear infections, as you know, are a great misery for many families.

We do know that symptoms go way down when we do the surgery, and that there are few side effects from having tympanostomy tubes placed.

As many of you may know, when there is fluid in the middle ear, children don't hear as well.

This fluid is caused mostly by anatomy, as well as frequent ear infections.

Ninety-nine percent of kids outgrow this problem, sometimes as early as age 3, certainly no later than age 8.

Once upon a time, we did tonsillectomies for frequent sore throats, especially when strep was involved.

An example of this is vision.

If you don't develop good vision in both eyes at an early age, you may never do so, i.e., one eye has poor vision and remains that way forever. This condition is called amblyopia. (Crossed eyes is the most common but by no means the only cause of this problem.)

Could this happen to children who don't hear well?

If they spend a lot of their preschool years not picking up language, will they always be behind?

A recent article in the New England Journal of Medicine shows this is not the case.

In Pittsburgh, they have been following children for years and compared those who got ear tubes right away with kids who did not. 

The theory was that tonsils harbored strep and getting rid of tonsils got rid of strep.

This was also a big deal because strep is known to lead to rheumatic fever, a much more dangerous condition.

Occasionally, there were some bad outcomes due to the surgery but mostly kids did very well.

The attitude back then was, well, it may not do much, but there isn't much risk involved.

Well, as it turns out, it did far less good than people thought. Kids still got strep throat.

In the 1960s and '70s, the number of tonsillectomies went way down and has stayed there.

We have had a little bit of an increase in these surgeries in recent years, but for other reasons.

The reason that tympanostomy tubes were promoted was because of their effect on language.

Children with chronic fluid in their ears can be a little behind in talking.

When the tubes are placed, and the child is hearing well every day, the acquisition of new speech can be dramatic. But does it make a difference in the long run?

There is a concept called "developmental windows" that says that there is a certain age when things should develop, and, if they don't, it will be difficult for those skills to develop later. no difference in these two sets of patients when they got to third or fourth grade.

In other words, ear tubes may help a 2-year-old speak better, but that will have no bearing on how well they do with language when they are 10 years old.

There also was no correlation between how many months the kids had fluid in their ears and their academic performance.

There are many other reasons to do the procedure, of course, including the child's comfort. But you are doing no harm if you just allow nature to take its course and not place ear tubes.

It is important to note that fluid in the ears goes away for good when kids get older.

(The exceptions are most often kids with congenital syndromes, such as Down syndrome.)

So you don't need to get ear tubes for the sake of a child's eventual language development. Your kid will be just as smart in school.

(2/11/07)

Dr. Norton's column appears on the second Monday of each month in the Milwaukee Journal Sentinel and is reposted here. Contact Dr. Norton by phone at (414) 228-4800 or via e-mail.

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