Study: Delaying ear tube surgery won't harm children's development

Considering ear tube surgery to combat your baby's chronic ear infections? A study published in The New England Journal of Medicine says waiting to see if the infections go away on their own won't hurt your child's development and could spare them from going under the knife.

Middle ear infections, called otitis media, are extremely common in infants and children younger than three years of age. Such infections are caused when viruses or bacteria pass through the Eustachian tube into the middle ear. Children who are in daycare, who have parents who smoke, and who have allergies which cause congestion are among those who face an increased risk for such infections.

While middle ear infections are often treated using antibiotics, ear tube surgery can drain fluid from the middle ear and prevent future infections. In fact, such procedures are among the most common surgeries for young children.

But researchers at Children's Hospital of Pittsburgh say there's no harm in waiting to see if the infections go away before deciding to subject your child to surgery. Their study doesn't assess the effectiveness of ear tube surgery at preventing future infections, but it does look at the developmental impact of delaying the procedure.

In the study, researchers followed 429 infants who had persistent middle ear infections. The subjects were randomly assigned to either promptly undergo ear tube surgery or to wait six months if they had fluid build-up in two ears or nine months if they had fluid in one ear. By the end of the study period, 113 out of 213 of the children assigned to the delayed surgery group had not required ear tube surgery.

At the age of six, 395 of the children underwent a battery of tests, assessing their intelligence, vocabulary, and behaviour at school and at home. After accounting for maternal level of education, gender differences, and other factors, the researchers found no significant difference in speech or learning development between the children who underwent ear tube surgery and those who did not.

In the US, the American Academy of Family Physicians, the American Academy of Otolaryngology - Head and Neck Surgery, and the American Academy of Pediatrics recently issued new guidelines that children with recurring middle ear infections be examined at three to six month intervals if effusion (fluid) is still present in the middle ear to monitor for hearing loss or other problems, rather than undergoing ear tube surgery.

"Our findings support the recommendation not to insert tubes simply on the basis of persistent effusion and seem generally applicable to children in primary care settings in whom middle-ear effusion is an isolated condition," the authors write. "These data, together with the risks posed by the insertion of tubes, provide clear support for managing the treatment of such children conservatively." But the authors also note that this conclusion cannot be extended to children who aren't otherwise in good health, or who have hearing loss, cleft palate, Down's syndrome, or other conditions.