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Study raises questions about ear-tube surgery

http://www.jewishworldreview.com | (KRT) Hundreds of thousands of children each year in the United States get tiny tubes surgically inserted into their eardrums as a remedy for repeated, severe ear infections or a chronic buildup of fluid in the middle ear.

The tubes have been shown to reduce the number of infections in children who have recurring ear problems. Tubes also are thought to be a good idea for children with persistent fluid buildup because the condition can muffle hearing, which could interfere with speech and language development.

But new studies are raising questions about whether ear tubes for children with fluid buildup makes a difference in long-term development.

Dr. Jack Paradise, a researcher at Children's Hospital of Pittsburgh, has been tracking several hundred children who were diagnosed with persistent fluid in the middle ear, comparing a group who got ear tubes put in fairly quickly to a group who got the tubes after a longer waiting period, or in some cases not at all.

In a report published in August in the journal Pediatrics, his research team said no significant differences were found at age 4 between the two groups in language, speech and other development measures - a finding that raises questions about the use of tubes simply because of worries about development.

Whether such findings will translate into fewer ear-tube surgeries isn't clear.

Doctors use varying criteria for deciding whether to recommend ear tubes - which must be inserted with the child under general anesthesia and at the cost of a couple of thousand dollars - for any given child. Children will often be referred for ear tubes if fluid in the middle ear does not clear up after three months and there are signs of hearing loss.

The American Academy of Pediatrics is working with two other professional groups on new guidelines on the use of ear tubes for fluid buildup, which should help clarify their use.

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Allan Lieberthal, a California pediatrician serving on the committee, said one of the recommendations will likely be for "more observation before tubes are considered."

"In addition to the presence of fluid, doctors need to consider the fluid's effects on hearing and speech before determining if tubes are needed," he said.

The tubes, called typanostomy tubes, are inserted into the ear drum, allowing air to get into the middle ear. That helps relieve pressure and allow for better drainage of pus and fluid through the ear canal.

William Potsic, director of pediatric otolaryngology (ear, nose and throat surgery) at Children's Hospital of Philadelphia, said that as far as children being referred for ear tubes, he has seen little change. But he said doctors seem to be making referrals quicker for those children with recurring infections - perhaps because of the worry over giving repeated courses of antibiotics.

Despite the latest study questioning the benefits of ear tubes in regard to children's long-term development, Potsic said he sees plenty of valid reasons for putting ear tubes in children with chronic fluid buildup and hearing loss.

"If you ask parents, 'Is it OK for your child to have a hearing loss for six out of nine months of the school year while they are supposed to be embracing the educational environment?', most parents won't tolerate that."

David Zwillenberg, chief of pediatric otolaryngology at St. Christopher's Hospital for Children in Philadelphia, said each case has to be evaluated individually. He said children who are already lagging in development might fall further behind if hearing problems caused by fluid buildup are allowed to persist.

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