Ear Tubes Not Always Needed
Treating Buildup of Middle-Ear Fluid With Tubes May Not Improve Developmental Issues
Jan. 17, 2007 -- Hundreds of thousands of toddlers and preschoolers in the
U.S. get ear tubes each year, but a landmark study shows that a large number
may not need them for the purpose of avoiding future developmental
Researchers followed otherwise healthy children treated as toddlers for
persistent middle-ear fluid buildup until they reached ages 9 to 11 to
determine if treatment choices affected their overall development.
Fluid buildup by itself is usually not painful, but it does affect hearing
in the short term.
The thinking has been that these early hearing problems could lead to
long-term language and developmental impairment.
Some of the children in the study got tubes soon after they were diagnosed,
while others had tubes put in after a six-to-nine month observation period.
Some of the children never got tubes at all.
Early treatment with tubes was not shown to improve developmental outcomes,
as measured by a battery of tests conducted throughout the children's lives, up
to ages 9 to 11. The tests included checks of reading, spelling, writing,
behavioral issues, social skills, and intelligence.
The findings are published in the Jan. 18 issue of The New England
Journal of Medicine.
"We saw no differences at age 3, 4, 6, and now 9 to 11," researcher
Jack L. Paradise, MD, tells WebMD. "It is not likely that differences
between the two groups would emerge later in life, so this is pretty
The report does not address the usefulness of tubes for the treatment of
kids with repeated, painful ear infections. But it does show that tubes may not
be an appropriate option for children who simply have persistent middle-ear
fluid. Fluid can build up following an ear infection, but it can occur without
a history of ear infection as well.
Ear Tubes vs. Treatment Delay
Paradise and colleagues enrolled 6,350 healthy infants in their study
between 1991 and 1995. Just over 400 of the children were diagnosed with
persistent middle-ear fluid before age 3. About half got tubes immediately and
the other half did not.
Of the 196 children in the delayed-treatment group (up to 9 months later)
followed until at least age 9, 88 got tubes after close observation and 108
never got them.
"When treatment was delayed, many of these children ended up not getting
tubes," Paradise says. "Of those who did get tubes, a fair number got
them because they were also experiencing repeated ear infections."
Earlier findings from the study were so convincing that they prompted a
change in guidelines regarding the treatment of kids with persistent middle-ear
Doctors are now urged to take a watch-and-wait approach to treatment, which
includes frequent hearing assessments.
If a hearing loss of 40 decibels or higher is documented or language delays
are seen, tubes are recommended.