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Will tubes help prevent my 12-month-old’s ear infections?
Q: My daughter is 12 months old and has had six ear infections. She currently has a small infection in her left ear. Her doctor has prescoted medicine for five days and mentioned to me that if it doesn’t clear up this time, she is a good candidate for tubes. Should I rush into getting tubes for her, or will she outgrow these ear infections?
A: Trish, it can be very frustrating when your baby has repeated ear infections—dealing with your baby’s discomfort, the sleepless nights, the trips to the doctor, and different medications. Although most children get at least one ear infection (known as “acute otitis media”) during their first three years, some children are susceptible to repeated ear infections. After an ear infection, fluid can sometimes remain in the middle ear—this is known as “otitis media with effusion.” Since persistent ear infections and fluid can sometimes affect a child’s hearing and language development, it’s important to try to prevent them.

Thankfully, most children outgrow their frequent ear infections between 18 months and 3 years of age. Since most ear infections occur during the fall, winter and spring months, you might consider waiting to see whether your daughter is healthier over the summer. Ask the doctor to check for fluid in your baby’s ears after the infection is gone; and also check her hearing—if her ears are clear and her hearing is okay, that’s a good sign. In the meantime, make sure you do everything you can to prevent another ear infection:

  • Don’t smoke or let anyone smoke around your baby. Exposing your baby to tobacco smoke increases her chance of getting ear infections, colds, bronchitis, pneumonia, and asthma. If you smoke, get help to quit smoking. Try to keep your home and car smoke-free.

  • Feed your baby sitting upright. This applies to breastfeeding and bottlefeeding. When you feed your baby lying down or give your baby a bottle in bed, milk and germs can enter the Eustachian tubes in the back of her nose/throat and make ear infections more likely.

  • Make sure your baby gets her vaccines on time. Two new vaccines, in particular, help prevent ear infections:
  • The Prevnar vaccine protects children against the Pneumococcus bacteria, which is the most common bacteria causing ear infections as well as pneumonia, blood infection, and meningitis. Your baby should get this vaccine at 2, 4, 6 and 12-15 months of age.

  • The influenza or flu vaccine is now recommended for babies from 6–23 months because it significantly reduces ear infections, flu, and pneumonia. The first time babies get this vaccine, they are usually given two doses, one month apart.
  • Limit your baby’s exposure to germs. Follow good hygiene and hand-washing practices at home and in childcare. Infants who attend childcare with larger groups of children are exposed to more germs, so consider looking for a childcare setting with fewer children.

  • As your doctor said, you might also consider more aggressive medical treatment to prevent future ear infections. This is often recommended when babies have three or more ear infections within six months, or four or more ear infections within12 months; if fluid remains behind the eardrum for more than six months; or if fluid remains behind the eardrum for more than three months and there is some hearing loss. Ask your doctor about getting a second medical opinion from an ear, nose and throat specialist (otolaryngologist). The options include:

  • Continuous, preventive antibiotic treatment: Antibiotics are usually prescoted at a lower dosage, given once or twice a day. This can help reduce the number of ear infections. However, some children experience stomach upset and diarrhea when they take antibiotics.

  • Surgery to insert tubes in her ears: Known as “myringotomy” tubes, these are tiny metal or plastic tubes (about the size of a small bead) that are inserted into your child’s ear drums. The surgery is done under general anesthesia in the hospital or surgery centre, it take about 10 minutes, and children usually return home within a few hours. The surgery and tubes help drain the middle ear fluid, equalize the pressure, prevent fluid build-up and ear infections, and restore hearing. The tubes usually fall out on their own within 6-18 months. The only minor inconvenience is avoiding water getting in your child’s ears during bathing or swimming. Although this is considered a very safe surgery, any surgery has risks, so be sure to discuss all the advantages and disadvantages with your doctor first.

  • Other medical treatments: Some doctors believe that antihistamine/decongestant medication may help reduce ear infections in children who have allergies. Some doctors may also suggest alternative medical treatments.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician