Waiting for Ear Tubes Won't Affect Child Development

The implanted devices are often used to ease persistent fluid build-up

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HealthDay Reporter

WEDNESDAY, Jan. 17, 2007 (HealthDay News) -- Parents don't have to rush to make a decision about whether or not to have ventilating tubes placed in the ears of a child who suffers from persistent fluid in the ear.

That's the conclusion of a new study published in the Jan. 18 New England Journal of Medicine. It found no significant or lasting hearing-linked developmental delays in affected children who did not have ear tubes inserted right away.

"Parents don't need to rush into tubes on the basis of persistent fluid," said the study's lead author, Dr. Jack Paradise, professor emeritus of pediatrics at the Pittsburgh School of Medicine and the Children's Hospital of Pittsburgh.

"Parents can be reassured that if their child has a collection of fluid behind the ear drum during the first three years of life, we are now sure that the mild to moderate hearing loss associated with that fluid does not have any effect on language development, behavior, later learning or academic performance," added Dr. Stephen Berman, a professor of pediatrics at the University of Colorado and the Children's Hospital Denver, and past president of the American Academy of Pediatrics.

Berman wrote an accompanying editorial in the same issue of the journal.

Each year, U.S. doctors implant between 300,000 and 500,000 ventilating ear tubes in young patients, according to Berman, who estimates the surgery costs between $3,500 and $5,000. He added that up to 80 percent of these surgeries are performed because of middle ear effusion (fluid in the ear). There have been concerns that delaying such procedures could affect language development and learning, however.

In the past, physicians recommended the surgery because several retrospective studies did suggest an association between fluid in the ear and developmental impairments.

"We were worried that the fluid would delay language development and cause problems with attention and behavior," said Berman, who added that, "This study clearly shows that putting the tubes in doesn't have an effect on those problems."

The new study involved 6,350 infants who were regularly evaluated for middle ear effusion during the first three years of life. During that time, 429 children were found to have persistent fluid in their ears -- meaning that the fluid was present for longer than 90 days.

The children were randomly assigned to promptly undergo ear tube surgery or to wait, sometimes for as long as nine months, before having the procedure done. The researchers periodically assessed the children until they were 9 to 11 years old, and at the end of the study had complete data from 391 youngsters -- 195 from the prompt-surgery group and 196 delayed-treatment group.

One hundred and eight children in the delayed group ended up never having the ear tube surgery.

All of the children underwent a battery of developmental assessments tests when they were 3, 4, 6 and between 9 and 11 years of age.

The result: No statistically significant differences were found between youngsters who quickly received ear tubes and those who were asked to wait.

"We found no differences in outcomes," said Paradise.

That doesn't mean that tubes should never be used, however. There are certain times when ear tubes are warranted, according to Paradise and Berman. Children who have frequent ear infections -- more than three episodes in six months or more than four episodes in a year, according to Berman -- may have fewer infections and suffer less pain if they get ear tubes.

Berman also said that if the pressure from the fluid is so high that it causes damage to the small bones of the ear, tubes are indicated. But, he said, that's a very rare problem. There are also conditions that put children at an increased risk of having developmental problems from persistent fluid, and those children should probably get tubes.

The bottom line, said Paradise, is that "if your child isn't otherwise ill, and there are no problems with frequent infections, they ought to have hearing tests every few months and be observed to see that nothing untoward is happening in the ear."

"It's fine to watch children and not have tubes put in," concurred Berman. "Your child should periodically see their pediatrician to make sure no developmental or language delays are occurring and that the hearing loss hasn't become severe."

More information

There's more on fluid in the ears at the American Academy of Pediatrics.

SOURCE: Jack Paradise, M.D., professor emeritus of pediatrics, Pittsburgh School of Medicine and the Children's Hospital of Pittsburgh, Pa.; Stephen Berman, M.D., professor of pediatrics, University of Colorado School of Medicine and the Children's Hospital Denver, and the past president of the American Academy of Pediatrics, Denver, Colo.; Jan. 18, 2007, New England Journal of Medicine

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