Surgery for Ear Tubes

One syndicated doctor's column had the headline ''Good news on ear infections.'' The column about ear tube surgery explained that ''the benefits of this simple surgery may be astonishing: no more pain, no antibiotics, no hearing disability.''The implication was that modern medicine had found a wonderful solution. However, a study in the prestigious Journal of the American Medical Association (4/27/94) concluded that each year several hundred thousand children in the US may be receiving tympanostomy tubes that offer them ''no demonstrated advantage over less invasive therapies, and may place them at increased risk for undesirable outcomes.'' (National Institute of Health pub., NIDCD Ear Packet 9/96.)

A surgeon's group responded, saying that the study was prejudiced and inaccurate and that tympanostomy tubes produce ''immediate and satisfactory results.'' (National Institute of Health pub., NIDCD Ear Packet 9/96.) Not mentioned was the staggering cost for such a quick surgery, starting at $3,500 including hospital stay.

The columnist wrote that his son had to have four such operations during a period of 2 years as the tubes were prematurely rejected.

Is subjecting a small child repeatedly to hospital surgery, including general anesthesia, a ''good'' solution?

Science News, 2/08/03 reports:

''General anesthetic drugs that physicians commonly administer to children undergoing surgery, when given to baby rats, trigger brain cells to commit a cellular form of suicide that leads to memory and learning deficits, neuroscientists have found. So far, there's no evidence of similar effects in children who have received anesthesia, researchers say...''

Whether anesthesia's effects on young rats are relevant to people isn't known. Until it is, the results suggest ''if surgery does not have to be performed early in life, it would be prudent to postpone it, says study coauthor John W. Olney, a neuropharmacologist at Washington University in St. Louis.''

A commentary in Discover magazine (July '98, p106) written by a brain surgeon raises the issue of unknown long term consequences for many operations, and the lack of regulation governing surgery. He says:

''Although the FDA... regulates surgical devices like heart valves and pacemakers, it has no jurisdiction over surgical procedures. Unlike pharmaceutical companies, surgeons have no legal obligation to prove operations at the Phase III (highest FDA) level before marketing them. Moreover, since they can bill for any surgery, proven or unproven, surgeons have scant incentive to subject one of their ''cash cow'' operations to randomized testing.''

Is subjecting a small child repeatedly to hospital surgery, including general anesthesia, a ''good'' solution? It may be necessary for a few, but as the studies above suggest, it seems to be over-done and expensive, with a questionable long-term outcome.

As far as we know there has been no study of the long term effects of putting tubes in kids ears, and not likely to be. The immediate results are often a great relief - no more pain, no more sleepless nights, improved hearing, and as long as insurance pays the stiff medical bill everything is fine - maybe. But we don't know.

It seems prudent to do everything that you can to avoid ear surgery, using it only as a last resort, not a quick fix. See the other pages on Prevention and Waiting for more things that you can do to head off ear infections.

If current guidelines are followed to allow the body time to build resistance, with fewer infections treated with antibiotics, then surgery should be even less necessary. Avoid surgery as a quick fix. Try to exhaust all other possibilities first.