A study has found that, compared with antibiotics, placing tympanostomy tubes in small children’s ears provides no long-term benefit in reducing recurrent ear infections.
The study included children ages 6 to 35 months who had had at least three episodes of middle ear infections (acute otitis media) within a 6-month period.
Children who had had at least four episodes within a 12-month period, with at least one of those episodes occurring in the preceding 6 months, were also included.
The children were randomly assigned to receive either placement of tympanostomy tubes along with antibiotic ear drops or oral antibiotics as needed for infections.
Tympanostomy tubes are very small cylinders made of either plastic or metal that are surgically placed into the eardrum. They create an airway that ventilates the middle ear and prevents fluids from building up behind the eardrum.
AntibioticsTrusted Source are medications that can either kill bacteria or make it more difficult for them to multiply.
Following assignment, the researchers then measured the outcome based upon the average number of episodes of middle ear infections per child during a 2-year period.
At the end of the 2-year period, the researchers found that there was no real difference between the two groups in how often they developed ear infections or in how severe those infections were.
Among the children who received oral antibiotics, there were also no signs of increased antibiotic resistance.
Antibiotic resistanceTrusted Source is a concern because antibiotic-resistant bacteria can be difficult, or even impossible, to treat.
It’s previously been believed, said lead author Dr. Alejandro Hoberman, director of the division of general academic pediatrics at UPMC Children’s Hospital and professor of pediatric research at the University of Pittsburgh School of Medicine, that oral antibiotics would be more likely to cause antibiotic resistance than antibiotic drops applied inside the ear since ear drops would only affect the local area.
The study also found no difference between the groups in the children’s quality of life or in the effect of the children’s illness on the parent’s quality of life.
Dr. Brandon Hopkins, a pediatric ear, nose, and throat specialist at Cleveland Clinic, who was not involved with the study, said he feels that this finding should be looked at further as there is a “trade-off of burdens” that comes with the choice between oral antibiotics or tubes.
“For instance, children with severe pain intolerance to antibiotics, frequent doctors’ visits, missed work, etc., may be good candidates for ear tubes,” he said.
“Ear tubes decrease discomfort with acute otitis media and they decrease the need to go to doctors’ offices for treatment as you can treat them with antibiotics ear drops at home in many cases,” Hopkins said.
Hoberman said “we will probably take a deep breath before going ahead and placing tympanostomy tubes in children.”
He expects that we will probably watch and follow children with ear infections rather than rushing to place tubes in their ears.
If they continue to have recurrent ear infections (for example, two infections in 3 months or three infections in 6 months), then that small proportion of children would probably benefit from the placement of tubes, he said. The majority, however, won’t need to have tubes.
Hoberman said this is because one important finding of their study was that, over time, the rate of ear infections declined.
The rate of infections was 2.6 times greater in children under 1 year of age than it was in the older children in the study, regardless of which treatment they received.
“So, the whole idea is that time makes things better too,” he said.
Hoberman explained that most children outgrow ear infections as the eustachian tube, which connects the middle ear with the back of the throat, begins to work better.
However, he acknowledged that, for those few who continue to experience ear infections as they grow older, the placement of tympanostomy tubes may be helpful.
Hoberman also noted that most of the previous studies dealing with this topic were conducted before the development of the pneumococcal conjugate vaccine. His study is one of a few that have been done after the vaccine became a part of the childhood vaccination schedule.
This vaccine is effectiveTrusted Source in preventing acute middle ear infections associated with Streptococcus pneumoniae bacterium in children. This bacterium is the most common cause of these infections.
Hopkins added, “I think this study does a great job of clarifying that ear tubes do not prevent ear infections. This makes sense and has been longstanding in my discussions with families,” he said.
“Placement of ear tubes should be for quality-of-life purposes,” Hopkins concluded.