Many children get middle ear infections. This is known as otitis media (OM). The infections are most common in kids between the ages of 6 months and 2 years, although children of all ages may occasionally suffer from OM. Some kids are particularly susceptible because of environmental and lifestyle factors. These risk factors include attendance at a large group child care, secondhand tobacco smoke, and taking a bottle to bed.

Although the infections are relatively easy to treat, if a child has had multiple ear infections that do not get better easily or has evidence of hearing loss or speech delay, a doctor may suggest ear tube surgery (also called bilateral myringotomy and tubes, or BMT). During this surgery, small tubes called tympanostomy tubes are placed in the eardrums to ventilate the area behind the eardrum and keep the pressure equalized to atmospheric pressure in the middle ear. Approximately 2 million tympanostomy tubes are placed in children in the United States each year to help chronic middle ear infections.

Otitis Media

The middle ear is an air-filled cavity located behind the eardrum. When sound enters the ear, it makes the eardrum vibrate, which in turn makes tiny bones in the middle ear vibrate. This transmits the sound signals to the inner ear, where nerves relay the signals to the brain.

We all have a small passage leading from the middle ear to the back of the nose called the eustachian tube, which equalizes the air pressure between the middle ear and the outside world. (When your ears pop while yawning or swallowing, your eustachian tubes are adjusting the air pressure in your middle ears.) Bacteria or viruses can enter the middle ear through the eustachian tube and cause an infection — this often occurs when a child has had a cold or other respiratory infection. When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is bacterial. Pressure from this buildup pushes on the eardrum and causes pain, and because the eardrum cannot vibrate, the child may experience a temporary decrease in hearing.

With treatment, a bacterial infection can be quickly cleared up. In most children the fluid will typically resolve over time and the child's hearing will be restored. Some medical literature suggests that long periods of hearing loss in young children can lead to delays in speech development and learning.

Symptoms and Diagnosis of Otitis Media

Symptoms of otitis media include:

• pulling or rubbing the ears because of ear pain
• fever
• fussiness or irritability
• fluid leaking from the ear
• changes in appetite or sleeping patterns
• trouble hearing

See your child's doctor if you think your child has an ear infection. He or she will perform a physical examination and look at your child's eardrums. If the doctor suspects a bacterial infection (often based on the presence of pus behind the eardrum), treatment will begin immediately. A good understanding of the typical bacteria that cause OM can guide the physician in which antibiotics to use.

In some instances, the physician may need to use a needle inserted through the eardrum to suck out a sample of the pus from the middle ear for a laboratory culture. Called a tympanocentesis, this procedure can more specifically guide the antibiotic therapy.

Treatment

Although ear tube surgery is a relatively common procedure, surgery is not the first choice of treatment for otitis media. Antibiotics may be the first course of treatment for bacterial ear infections; however, acute ear infections may resolve without treatment of any kind.  Many ear infections are viral and cannot be treated with antibiotics. These infections need to get better on their own, and only time can help them heal.

But if your child's ear infections recur frequently and do not resolve easily, or if your child has a hearing loss or speech delay, the doctor may suggest surgery to drain fluid from the middle ear and insert a ventilation tube. Because most children have had infections in both ears, surgery is typically done in both ears, called a bilateral procedure. A tiny tube, also called a pressure equalization (PE) or tympanostomy tube, is inserted into the eardrum. It serves to ventilate and equalize pressure in the middle ear. This will help to prevent infection, the accumulation of fluid, and subsequently will normalize hearing.

The presence of the tiny hole in the eardrum from the tube doesn't impair hearing (children with a speech or language delay from hearing loss often will benefit from the normalization of their hearing thresholds). Depending on the type of tube used, the tube remains in place for about 6 months to 18 months or more. Tympanostomy tubes greatly reduce the occurrence of further ear infections.

Tympanostomy Tube Surgery

If your child is old enough to understand what surgery is, you may want to prepare him or her for the visit by talking about what to expect. The following steps will be taken during ear tube surgery:

• Your child will receive general anesthesia. This means the surgery will be performed in a hospital so that an anesthesiologist can monitor your child. Typically the procedure takes about 10 to 15 minutes.
• The surgeon will make a small hole in the eardrum and remove fluid from the middle ear using suction. Because the surgeon can reach the eardrum through the ear canal, there is no visible incision or stitches.
• The surgeon will finish by inserting a small metal or plastic tube into the hole in the eardrum.

After the procedure, your child will wake up in the recovery area. In most cases, the total time spent in the hospital is a few hours. Extremely young children or those with significant medical problems may stay for a longer period.

After Surgery

A tympanostomy tube helps prevent recurring ear infections by allowing air into the middle ear. Other substances, including water, may sometimes enter the middle ear through the tube, but this is generally not a problem. Your surgeon may or may not feel that earplugs are necessary for regular bathing or swimming.

In most cases, surgery to remove a tympanostomy tube is not necessary. The tube usually falls out on its own, pushed out as the eardrum heals. A tube generally stays in the ear anywhere from 6 months to 18 months, depending on the type of tube used. If the tube remains in the eardrum beyond 2 to 3 years, however, it will likely be removed surgically to prevent a perforation in the eardrum or accumulation of debris around the tube.

Although effective in reducing chronic ear infections, ear tubes are not always a permanent cure for otitis media. Up to 25% of children who need ear tubes before the age of 2 may need them again.

Reviewed by: Robert C. O'Reilly, MD, and Thierry Morlet, PhD
Date reviewed: June 2006
Originally reviewed by: Steven P. Cook, MD