When a young child has chronic ear infections, a common form of treatment is to surgically place tubes in their ears for two years.
But researchers from UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh have found no long-term benefit to the tubes compared with the alternative: giving the child oral antibiotics.
Dr. Alejandro Hoberman, lead author of the study and director of General Academic Pediatrics at Children’s, said the study is significant. Placing tubes is one of the most common surgeries performed on children, with recurrent ear infections being the most common reason.
“This is a pretty common thing, tympanostomy tubes,” Hoberman said. “It has substantial impact.”
Five out of six children have an ear infection before their first birthday, according to the National Institute of Health. Tubes are typically used to reduce the likelihood of ear infections in children who have several infections a year, and they also allow parents to apply antibiotics through ear drops, rather than by mouth. (Hoberman said there are concerns about antimicrobial resistance – when bacteria grows resistant to medicines – with oral antibiotics.) The tubes are inserted into the ear drum and are meant to create ventilation in the ears, preventing fluid from accumulating behind the ear drum.
But the surgery does come with certain risks: anesthesia is associated with developmental issues in young children, and the tubes themselves can cause scarring or long-term perforation of the ear drum, have issues with blockage or extrude from the ear drum sooner than they’re supposed to.
“Really, you don’t want to do it if you really don’t need it,” Hoberman said. “And if there’s no benefit, or the benefit is only in a smaller proportion of children, this enables us to decrease the use of tympanostomy tubes…substantially.”
Hoberman noted that most prior studies relating to ear infection treatment occurred before the development of the pneumococcal conjugate vaccine, which reduced the proportion of children with recurring ear infections since it became routine in 2000. But studies that have occurred since the vaccine was introduced have been short-term or looked at a relatively small number of children, he said.
UPMC’s trial results were published Wednesday in the New England Journal of Medicine. Hoberman and his team enrolled 250 children aged 6 to 35 months old at UPMC Children’s Hospital, Children’s National Medical Center in Washington D.C. and Kentucky Pediatric Adult Research in Bardstown, Kentucky. All of the children had recurrent ear infections and had received the pneumococcal conjugate vaccine, and were randomly assigned to receive either oral antibiotics during infections or the surgical insertion of tubes and antibiotic ear drops. Researchers followed the children for two years.
Overall, the researchers found no difference between the two groups when it came to the frequency or severity of ear infections. There was no evidence of antimicrobial resistance in either group. The trial also found no difference in the quality of life in either group.
“In my mind, if there is not a reduction in the number of ear infections that we were expecting to find, and there’s not a negative impact in causing an increase in antimicrobial resistance, why take the chances of potential risks of anesthesia and the risks of tympanostomy tubes?” Hoberman said.
The study found that in both groups, the rate of ear infections among children fell as they got older. The infections rate was 2.6 times higher in children younger than 1 than it was in those between 2 and 3 years old. This finding may allow up to 75% of children with recurring infections to avoid tubes, Hoberman said – parents can manage ear infections with oral antibiotics a bit longer, to see if their child naturally grows out of it.
“With the findings of our study, we feel that in most instances, children…can be safely watched and treated with antibiotics every time they have an ear infection for a little bit longer period of time,” Hoberman said, “Instead of rushing into tubes after they had three ear infections in six months, assume that most children, with time (will improve).”
Teghan Simonton is a Tribune-Review staff writer. You can contact Teghan at 724-226-4680, [email protected] or via Twitter .