Ear tubes are inserted for a variety of reasons including recurrent ear infections, breakdown of the eardrum with impending cholesteatoma formation and chronic ear fluid.       Click on colored text for word definitions !!

The Treatment of Chronic Ear Fluid ( Chronic Serous Otitis Media ):  
 

• What Works:  
     
  • The initial treatment of chronic ear fluid is often with antibiotics.  Even serous or clear fluid will often harbor bacteria.  View Abstract  View Abstract  View Abstract   However, some studies using ampicillin have shown this not to be effective:  View Abstract
  • After fluid is present for 3 months in both ears, ear tubes can be considered.  Ear tube placement should be considered in the treatment of long standing ear fluid.  View Abstract
  • An adenoidectomy has been shown to be effective in the treatment of serous otitis media.  This is a larger operation with more complications and is used as a treatment option in severely affected children (second tube being placed) that are four to eight years old.  View Abstract   View Abstract
    
    Joint Statement From The The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery
    
    Adenoidectomy should not be performed with the insertion of the first set of myringotomy (ear) tubes unless there is another indication for adenoidectiomy besides chronic otitis media.  However, repeat surgery for chronic otitis media should consist of adenoidectomy with myringotomy (with or without myringotomy (ear) tube placement.)  View Abstract
       
• What Does Not Work:
   
  • The combination of decongestants and antihistamines has been shown by multiple authors to be ineffective in the treatment of serous otitis media.  View Abstract   View Abstract   View Abstract      (These drugs may still be effective in children with a rhinitis or allergic nasal symptoms and by clearing the nasal symptoms.   It is possible that they may help the eustachian tube function and resolve the middle ear fluid.) 
  • Over-the-counter topical nasal decongestants.  View Abstract
  • Nasal steroids View Abstract have not been demonstrated to be effective in treating this disorder. 
  • Simply draining the serous fluid has not been effective. ( Although this may relieve pain in patients with acute otitis media. )  View Abstract    Myringotomy of an acute otitis media will relieve pain and discomfort but will not lower the incidence of developing serous otitis media after the infection.  Serous otitis media is present in 50% of the children 10 days after and 8% 10 weeks after an acute middle ear infection. View Abstract
  • Laser assisted myringotomy for recurrent acute otitis media and chronic serous otitis media  in children has been associated with a high failure and persistence of the disease and with eardrum perforation.  View Abstract    Koopman et..al. found that the eardrum hole from a laser myringotomy stayed open an average of 2.4 weeks compared to 4 months for a myringotomy tube.  The success rate for laser myringotomy was only 48% compared to 78% for ear tube placement.  Laser myringotomy was found to be safe but less effective than ear tube placement. View Abstract
     
• What Might  Work
   
  • Systemic steroids have been found by some authors to have limited effectiveness.   They are only used in combination with an antibiotic and may suppress the child's immunological resistance to acute infections.   View Abstract

The Treatment of Recurrent Ear Infections ( Recurrent Acute Otitis Media ): 

• What Works:
    
  • Prophylactic antibiotics have been shown to be effective in the prevention of chronic ear infections.  However, their use has diminished over the years because of concerns over the production of bacterial resistance to the antibiotics.   View Abstract
  • Ear tubes have been shown to be effective in the prevention of recurrent acute otitis media.  In many studies, their effectiveness exceeded prophylactic antibiotics.   View Abstract   View Abstract

The Treatment of the Breakdown of the Eardrum:  If there is any signs that there is still active eustachian tube dysfunction, an ear tube should be placed to prevent cholesteatoma formation.  A cholesteatoma is a skin cyst which forms from the eardrum retracting into the middle ear.  This cyst is chronically infected and if left untreated can rarely erode into the facial nerve causing paralysis of the face, the inner ear causing deafness, and dizziness and the brain causing meningitis and death. 

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