B O S T O N, April 19, 2001 -- Middle ear infections are the most common medical problem affecting pre-schoolers, and many parents send their children in for an ear operation to treat them.
About 700,000 children each year have ear tubes surgically placed to drain fluid and relieve the pressure, according to the American Academy of Otolaryngology-Head and Neck Surgery.
But a study released Thursday in New England Journal of Medicine suggests that many of those operations — designed to improve the speech and learning development of the youngsters — may not be worth either the risk or the cost.
"The bottom line," Dr. Jack L. Paradise of Children's Hospital of Pittsburgh told the Associated Press, "was there wasn't any difference in the developmental outcomes, as best we could measure them at age 3."
But researchers also caution that longer periods of fluid in the ears, or more severe hearing loss than found in those studied, could affect development; problems that didn't show up at age 3 may also resurface later.
ABCNEWS' Dr. Tim Johnson says the study should not make parents think they should completely discount tubes as a solution for some children with ear problems.
"If you've got this kind of child — not having recurring infections, but residual fluid in the ear — talk to a real expert about whether or not you need to put tubes in," he said on ABCNEWS' Good Morning America. "I think this study will say to them, 'Let's wait and see what happens.'"
Tubes Made No Difference
Almost all children experience middle ear inflammation at least once before age six, according to the American Academy of Pediatrics. Historically, the options have been either antibiotics or the ear-tube operation.
The Pittsburgh study looked at 402 children under age three who had fluid in the middle ear that lasted at least three months and was accompanied by mild to moderate hearing loss. One group of children has tubes inserted right away; the other had tubes inserted after the fluid in the ears had lingered for six to nine months.
At age 3, it was testing time. Researchers found no difference in the speech, language, cognition and psycho-social development between the two groups.
But Johnson points out that the study didn't look at children with severe hearing loss or those who had fluid in their ears for more than nine months. Nor did the study include children with acute, recurrent infections.
Furthermore, it tested the children at age 3 — when it is difficult to determine long-term effects. As the study continues, the two groups of children will be compared again at age six, as they start school. At that point, developmental testing is more accurate.
If the study holds up when the test subjects turn six, it will slow down the enthusiasm for quickly putting tubes in the ears of younger children with mild hearing loss or fluid, Johnson says.
Risks of the Operation
The procedure entails inserting tiny tubes in the eardrums to help clear out the fluid that can build up in their middle ear during an infection. The tubes are also designed to prevent more infections.
Parents send their children in for the operation out of concern that if the fluid lingers for weeks or months, it can cause hearing loss, and impact the child's speech, language and other development.
The tube procedure costs about $2,000, and carries a few slight risks, partly because children undergoing it are put under general anesthesia,.
"There are possible complications that can occur, such as scarring or permanent holes," says Johnson. "When you have tubes in, you have to prevent water from getting in the ears, which is not easy in young children. So it's not a totally easy or safe procedure."
Scientific evidence has also shown several environmental factors that may increase the risks of middle ear inflammation or middle fluid in the middle ear, according to the American Academy of Pediatrics.
Those environmental factors are: bottle feeding rather than breast feeding infants, exposure to second-hand smoke, and attending group child-care facilities.
Overall, says Johnson, parents should thoroughly analyze their decision with a real expert in the field, not just follow the first recommendation any pediatrician makes.
They also have to be willing to listen to a more conservative approach: As long as the child isn't facing real loss, or acute infection, they should sit tight and see what happens.