Coming Around to Ear Tubes
After Her Son's Fifth Infection, a Mom Reluctantly Agrees to Surgery

By Lindsay Moran
Special to The Washington Post
Tuesday, March 18, 2008

I'd been warned several times that this would be the worst part, that my 14-month-old son would have no recollection of this day, even though it would be forever burned in my memory. Still, nothing quite prepared me for holding Shep down as the anesthesiologist placed a small mask over his nose and mouth, drowning out his shrieks.

Months of frustration had persuaded my husband and me that it was time to go for "myringotomy with tube placement" -- a.k.a. ear-tube surgery.

It was my friend Perry who first suggested the surgery. "Gotta get tubes," he'd insisted, after my complaints about Shep's third double ear infection.

"Interesting," I'd responded, thinking, "No way." I pictured Shep with colossal rubber contraptions, like alien antennae, growing out of his ears.

Then Shep got his fourth and fifth double ear infections -- and, with his fever peaking at 104 and his screeching at night for hours on end, I started thinking seriously about tubes.

"They're microscopic," said Perry, whose son Jared was on his second set. But when Perry mentioned general anesthesia, I was back to "No way."

Shep had spent most of the fall and winter on antibiotics. While the infections at first seemed to respond well, Shep did not. My husband and I presided over a twice-daily torture session to get him to take the medicine, which left him with diarrhea, yeast infections and diaper rash. During the fifth bout of infection, Shep didn't seem to improve, even after several doses.

At a loss, I decided to tap into the collective wisdom of other parents, by typing "chronic ear infections" into the archives of a local parenting e-mail discussion group. Mistake!

I opened a Pandora's box of horror stories: repeat infections resulting in hearing loss; slow motor development; lack of coordination and balance; ruptured eardrums, as evidenced by "greenish-yellow pus" discharging from the child's ear.

And there was one more that troubled me: delayed speech. My older son, who never suffered from ear infections, had been considerably more verbal at the same age. Perhaps this explained why Shep still called me (and everyone else) "Daddy."

The only comfort was that the sheer volume of (sometimes desperate) postings suggested we were anything but alone. Indeed, according the American Academy of Otolaryngology -- Head and Neck Surgery, ear infections are the leading cause of pediatric doctor visits.

Embedded in these stories were also glimmers of hope: rousing endorsements not just of tubes, but of alternative options: homeopathy, acupuncture, chiropractic adjustments and more, for each of which there is only anecdotal evidence.

Putting aside my general skepticism of alternative approaches -- I maintain a staunch, perhaps naive, faith in people who have made it through the rigors of medical school -- I weighed the feasibility of a few.

I soured on homeopathy when I learned this involved more than administering minute doses of, say, bitterroot from the local health food store; it required extensive (not to mention expensive) consultation.

Chiropractic? Forget that. I couldn't even get Shep to lie still for half a minute while I changed his diaper.

Acupuncture also seemed out of the question. I couldn't imagine sticking Shep with more needles than absolutely necessary.

Eliminating dairy sounded easy enough, so I put Shep on rice milk. But he took one taste, gave me a betrayed look and hurled the bottle across the room, shouting one of the few words he knows, "NOOOOOOO!"

By the time I took Shep to see Mark Dettelbach at the downtown Washington office of the Feldman ear, nose and throat group, I had done my homework and learned that otitis media -- which sounded to me like a vengeful Greek god -- is the medical term for inflammation of the middle ear.

The reason that infants are so often afflicted with otitis media, caused by bacteria or viruses that allow pus and mucus to accumulate behind the eardrum, is anatomical. The inner ear is not developed enough to allow drainage of fluid from the eustachian tube, which connects the ear to the back of the nose.

An immature eustachian tube inclines at about 10 degrees, as compared with the 45-degree angle of an adult's. That's why many parents try to have their otitis-prone infants drink bottles sitting up, to prevent milk entering the inner ear.

The condition of fluid in the middle ear, or otitis media with effusion (vengeful deity meets wicked stepmother), can last for months, impeding hearing. Left untreated, it can cause delays in speech and language development and even lead to hearing loss.

After Dettelbach took a look in Shep's ears -- one of which he diagnosed as infected -- a technician led us to a padded booth. While an assistant focused Shep's attention forward (with a variety of stuffed animals), the technician called his name through two different speakers, at various volumes. I beamed with pride every time Shep responded, and I held my breath every time that he seemed not to hear.

Shep was experiencing about a 25-decibel hearing loss, Dettelbach told me. "Basically, it sounds to him like everyone is talking under water," he explained. "If it were you, I'd recommend a hearing aid."

The diagnosis convinced me: We would get the tubes, despite my lingering worries over the one in 100,000 risk of "incident" that Dettelbach said anesthesia posed in children.

The actual surgery -- performed on Shep in a suburban outpatient surgical center in early February -- involves making a small hole in the eardrum to remove fluid with a suction device. A surgeon then inserts a tiny tube, which provides ventilation. Typically, children can return to school or day care the following day. The tubes remain in place for six to 12 months before falling out on their own. The only downside is the necessity of earplugs for swimming.

Shep's surgery took the longest 18 minutes of my life. By the time Dettelbach emerged from the operating room, the sound of Shep's wails filled me with relief. He'd had so much fluid in both ears that a larger suction had been required to get it all out. "But everything went fine," Dettelbach said.

By the time I got to him, in the arms of a nurse, Shep was sucking down a bottle and clutching his favorite stuffed animal. He wailed all the way home. By that afternoon, however, he was beyond chipper, taking in everything around him with a conspicuous new level of alertness.

My personal payoff came the next morning when I stepped into Shep's room. He stood up in his crib, looked at me, and, for the first time ever, shouted "Mommy!" ¿

Lindsay Moran is a Washington area freelance writer. Comments:health@washpost.com.