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This one is about: Middle Ear Fluid in Young
Children, Part II
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Middle Ear Fluid in Young Children, Part II
This article was put out by the U.S. Department of Health and Human Services on
Middle Ear Fluid in Young Children. It's very comprehensive. Of course, it deals with
otherwise healthy children ages 1 - 3 yrs., and does not address the special
considerations of cleft affected children, but it's interesting reading nonetheless.
Middle Ear Fluid in Young
Children Part II
by U.S. Department of Health and Human
Services
Middle ear fluid can be treated in many ways. It is important to
know that a treatment that works for one child may not work for another. IF one
treatment does note work, another treatment can be tried. Please discuss each of the
treatments listed below with your child's health care provider. Be sure to ask about
the possible advantages and disadvantages of each treatment as well. Then, decide
with your child's health care provider on the treatment for middle ear fluid.
- Observation. Middle car
fluid often goes away without treatment. Some studies show that for most children
middle ear fluid clears after 3 to 6 months without treatment.
- Antibiotic Drug Treatment. Studies
show that middle ear fluid cleared slightly faster in some children given
antibiotic drugs than those not given antibiotics. However, antibiotics have some
unwanted effects, such as diarrhea, rash, and others. Also they can be expensive
and some children have trouble taking them. For these reasons, you and your child's
health care provider may want to try observation first.
- Surgery to put "tubes" in the ears. In
this minor operation, a small cut is made in the child's eardrum and fluid in the
middle ear is gently sucked out. Then a small metal or plastic tube is put into the
slit in the eardrum. A general anesthetic is used to put the child to sleep for
this operation. When the fluid is removed from the middle ear, the child's hearing
returns to its normal level.
Ask your child's health care provider about the costs and
possible harms of this surgery.
The tubes are left in place until they fall out, or until
your child's health care provider feels that they are no longer needed. About one
third (1 out of 3) of children with ear tubes need to have another operation to
insert new tubes within 5 years after the first operation.
The advantages and disadvantages of treatments for middle ear
fluid are listed in the following table. Please discuss these choices further with
your child's health care provider.
Observation:
Advantages:
- In about 60 percent of children, middle ear fluid goes away
without treatment within 3 months; in 85 percent it goes away within 6 months.
There is very little cost and no side effects of observation.
Disadvantages:
- Middle ear fluid does not go away in about 40 percent of
children in 3 months and in about 15 percent in 6 months.
Antibiotics:
Advantages:
- May increase chance (by about 14 percent) and speed of middle
ear fluid going away.
- May decrease chance of middle ear infection.
Disadvantages:
- Middle ear fluid may not go away.
- Unwanted drug effects (such as diarrhea, rash).
- Development of drug-resistant strains of bacteria.
- Bother of buying and giving drug.
- Cost of drug.
Surgery (tubes):
Advantages:
- Middle ear fluid goes away right away.
- Hearing returns to normal right away.
Disadvantages:
- Temporary discomfort for child.
- Risks of anesthesia.
- May need to protect ears during bathing and swimming while
tubes are in place.
- Some children need another surgery to place new tubes in the
ears.
- Eardrum changes possible.
- Time lost to take child for surgery.
- Most costly choice.
The treatment that your child gets for middle ear fluid depends
on: how long your child has had middle ear fluid and if the fluid is causing hearing
problems for your child.
Here are some examples of how your child might best be treated
for middle ear fluid. Remember to discuss all treatments with your child's health
care provider.
If your child has had middle ear fluid for up to 3 months, then
your child's health care provider may recommend one of these treatments:
- Observation OR antibiotic therapy. You and your child's
health care provider may choose observation because antibiotic therapy can cause
some unwanted effects.
- Taking steps to prevent middle ear fluid (especially keeping
your child away from cigarette smoke).
If your child has had middle ear fluid for 3 months or more, then
your child's health care provider may recommend the following treatments:
- Observation OR antibiotic therapy. You and your child's
health care provider may choose observation because antibiotic therapy can cause
some unwanted effects.
- Taking steps to prevent middle ear fluid (especially keeping
your child away from cigarette smoke). ALSO,
- A hearing test is recommended if your child has had middle
ear fluid for 3 months or more. If this shows that your child has a hearing loss in
both ears, your child's health care provider may recommend surgery to put tubes in
the eardrums.
- Talk to your child's health care provider about any other
concerns you may have about your child's development.
If your child has had middle ear fluid that has lasted from 4 to 6
months with a hearing loss in both ears, then your child's health care provider may
recommend: Surgery to put tubes in the eardrums. Tubes in the eardrums should clear
the middle ear fluid and return you child's hearing to normal. Discuss this surgery
with your child's health care provider. Also, find out if your child's ears should be
protected from water after the surgery and when to bring your child back for a
checkup.
A number of medicines and surgical treatments are not recommended
for young children with middle ear fluid. The medicines not recommended are:
Decongestants and antihistamines and steroids. Most studies show that decongestants
and antihistamines used together or alone did not improve or cure middle ear fluid.
There are not yet enough studies to tell whether steroids can cure or improve middle
ear fluid.
These surgical treatments are not recommended: Adenoidectomy
and Tonsillectomy. There are not yet enough studies to tell if adenoidectomy
(removing the adenoids--tissue at the back of the throat behind the nose) cures or
improves middle ear fluid in children younger than four years old. But it does seem
to help older children. Tonsillectomy (removing the tonsils at the back of the
throat) has not been shown to cure or improve middle ear fluid in children.
If your child's health care provider suggests one of these
surgeries, there may be another medical reason to do the surgery. Ask why your child
needs the surgery. If you are still unsure, you may want to talk to another health
care provider.
The information presented here was based on the Clinical
Practice Guideline, Otitis Media with Effusion in Young Children. The Guideline
was developed by a non-Federal panel of experts sponsored by the Agency for
Health Care Policy and Research. Other guidelines on common health problems are
available and more are being developed.
For more information about guidelines, call toll free
800-358-9295 or write:
Agency for Health Care Policy and Research
Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
This article was produced by:
U.S. Department of Health and Human Services
Agency for Health Care Policy and Research
Executive Office Center, Suite 501
2101 East Jefferson Street
Rockville, MD 20852
AHCPR Publication No. 94-0624
July 1994
Related Article: Middle Ear Fluid in
Young Children, Part I
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