Ear Tubes in Toddlers: When Surgery Becomes the Answer

bilateral myringotomy surgery

My son trying to escape the surgery center

 
Anyone who gets ear infections or has children who get ear infections know how brutal they can be.
 
We’ve been seeing our pediatrician pretty regularly when it comes to colds and congestion.  It’s never much of a surprise when the prognosis reveals a red, bulging eardrum and a back up of fluid in the middle ear.  
 
After several scripts of antibiotics and a final administration of 3 rounds of Rocephin injections (ouch) my son finally met the criteria to have ear tubes placed.
 
We made our initial appointment with the ENT and scheduled a hearing test with an audiologist.  
 
While my son can hear everything you say out loud (at a 60 decibel range or so) he is missing some more subtle sounds.  Most of the time these sounds come with the pronunciation of a word, which puts him at an increased risk for delayed speech development.
 
You can imagine how hard it is for a child who is learning language for the first time to distinguish sounds when what they hear is compared to being underwater.
 
Due to this concern and the frequency of his ear infections we scheduled an appointment for surgery.
 

Bilateral Myringotomy with tubes — What is it?

During this outpatient procedure the surgeon will make a small incision in each tympanic membrane (eardrum).  A small device will then be used to suction out the fluid that has accumulated in the middle ear.  Once this is done, the surgeon will place a small tube into each opening of the membrane.
 
These tubes act as a ventilation and drainage system for young children.  Until the age of about 6 years old the eustachian tubes in the ears are not fully formed.  Their size and position makes it hard for the ears to drain naturally, causing fluid to build up and bacteria to grow.
 

What to expect from surgery

The procedure only takes about 15 minutes from start to finish.  The hard part is not allowing your child to have anything to eat or drink after midnight the day of surgery.  (My son is a foodie and was definitely hangry the morning pre-op.)
 
General anesthesia will be used.  Because of my sons age at the time of surgery, he was put under using an anesthesia face mask.  Other cases may require IV anesthesia.
 
Your child will be groggy and fussy immediately following surgery.  This is due to the effects of the anesthesia.  It takes time for the meds to wear off leaving your little one a little confused and uneasy.  We spent about 30 minutes in the recovery room cuddling before we were out the door.
 
There is very minimal pain with this procedure.  If needed Tylenol or Motrin can be given to ease any discomfort. In my experience my child was back to his normal, rambunctious self within a couple hours after surgery.  He also attended daycare the following day.  (Be sure to warn them of the possibility of drainage – a little blood is expected and normal for the first couple of days post-op.)
 
The doctor will prescribe antibiotic ear drops.  These are to be used in accordance with the doctors orders.  For us, it was 3 times a day for 3 days.  We decided to do these at home so our daycare providers wouldn’t have to worry about administering them effectively.
 
You will be seen 3 weeks after surgery for a follow-up appointment.  The nurse and doctor will assess your child to ensure the tubes have remained in place and are healing properly.  They will also look to ensure there is no longer an infection present.  
 

How do I know if my child has an ear infection?

The only way to be properly diagnosed is by seeing your pediatrician.  They will do a health assessment and use an otoscope to look inside of the ear.  At that point they will come to a conclusion.  If necessary, they may prescribe antibiotics to clear up a bacterial infection.  In some cases, ear infections can clear up without the use of these medications.
 

Symptoms to look for include:

Ear tugging (this was always a strong indicator something was up, although it can also be a sign of discomfort from teething)
Irritability/pain
Trouble sleeping
Diminished appetite, slowed bottle feeding
Discomfort when lying flat
Muffled hearing
Loss of balance or coordination
Fever (very rarely did my son have a fever associated with an ear infection, but it is definitely something to watch for)
 
I always knew an ear infection was going to make its debut when I noticed Blake getting a cold.  It would start off harmless and then quickly turn a scary shade of green (usually indicating an infection) and begin uncontrollably oozing out of his nose and eyes.  Not too long after these symptoms showed up we would get a positive diagnosis for otitis media.
 

How to soothe the symptoms of an ear infection at home:

Cool mist humidifier (a necessity to help thin and loosen mucus)
Nasal saline spray
Nasal suction (to prevent further build up in the ear…I recommend NoseFrida — it’s effective, you can see the amount/characteristics of what’s coming out and it’s much easier to clean)
Warm compress on the ear
Children’s Tylenol or Motrin (ask your child’s pediatrician for recommended dosing based on your child’s age and weight)
  
bilateral myringotomy with tubes

Post-op snuggles with daddy

 

Is surgery the right choice for my child?

Because of my sons young age I was hesitant to schedule him for surgery, but I’m here to tell you that it was quick and very effective.  It seemed like he almost instantly had relief from all of the pain and pressure in his ears.

TMI — the doctor told me pus and mucus began pouring out of the small incision he made in the tympanic membrane indicating that his ears were badly and chronically inflamed.  It is very likely that all the antibiotics he was given over the course of a year didn’t even touch the infection that was brewing in his middle ear.  (This was a little concerning because I’m educated on antibiotic resistance and the harm associated with the overuse of these medications.)

Now that the tubes are in place, the symptoms of his colds will be lessened.  Another big plus is that we will no longer have to make a doctors appointment every time we suspect he’s ill.  If there’s drainage or an infection present all it takes is a call to get a prescription for antibiotic drops.  It definitely helps with my sanity and my PTO at work.  

UPDATE: We went for Blake’s follow up appointment and his tubes have remained in place.  His ears are looking great and his hearing test came back with NO deficit.  

Speak to your child’s pediatrician about the criteria for this procedure and if your little one is a good candidate for surgery.  Relief is on the way!

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