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Ear Infections - Surgery



Surgery

Children may be considered candidates for surgery if they have:

  • OME lasting longer than 4 months that is accompanied by hearing loss
  • OME that is persistent or recurrent (even if there is no hearing loss) and may put child at risk for developmental delays or structural damage to the ear
  • OME and structural damage to the eardrum or middle ear


Surgical Guidelines. The decision to pursue surgery needs to be determined on an individual basis. In 2004, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Academy of Otolaryngology-Head and Neck Surgery released the following general guidelines for surgical procedures:

  • Tympanostomy tube insertion is the first choice for surgical intervention. However, approximately 20 - 50% of children who undergo this procedure may have OME relapse and require additional surgery.
  • Adenoidectomy (removal of adenoids) plus myringotomy (removal of fluid), with or without tube insertion, is recommended as a repeat surgical procedure. Tube insertion may be advised for children younger than 4 years of age.
  • Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.
  • Neither myringotomy alone or tonsillectomy (removal of tonsils) is recommended for OME treatment.

Tympanostomy (with Myringotomy)

A tympanostomy involves the insertion of tubes to allow fluid to drain from the middle ear. The procedure involves:

  • A general anesthetic (asleep, no pain). Children typically recover completely within a few hours.
  • Myringotomy is performed first.
  • After myringotomy, thedoctor inserts a tube to allow continuous drainage of the fluid from the middle ear.
Ear tube insertion - series Click the icon to see an illustrated series detailing ear tube insertion.

Postoperative Effects. Tympanostomy is a simple procedure, and the child almost never has to spend the night in the hospital. Acetaminophen (Tylenol) or ibuprofen (Advil) is sufficient for any postoperative pain in most children. Some children, however, may require codeine or other powerful pain relievers. One study found that lidocaine eardrops were effective in relieving pain and stress after the procedure.

Complications. Otorrhea, drainage of secretion from the ear, is the most common complication after surgery and can be persistent in some children. It is usually treated with antibiotic eardrops. One study suggests that wearing earplugs mayhelp the problem.