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Study: Ear Tube Surgery for Kids Not Much Better Than Antibiotics

doctor looking in child's ear
Children treated with antibiotics have the same number of ear infections as those who get tubes.

Key Takeaways

  • Researchers analyzed children with regular ear infections who received ear tubes and just antibiotics.
  • There was no difference in the number of ear infections children had after surgery or treatment with antibiotics only.
  • Experts say ear tubes can still be a beneficial form of treatment.

New research finds that ear tube surgery on children with recurrent ear infections isn’t much more impactful than antibiotics.

Researchers analyzed data from 250 children with repeat ear infections, known as recurrent acute otitis media. They were treated with either tympanostomy-tube placement—a surgical procedure to insert tiny tubes into a child’s eardrums to help drain fluid—or antibiotics.

The study focused on children between the ages of 6 and 35 months who had either:

  • At least three ear infections within six months
  • At least four infections within 12 months, with one infection occurring within the past six months

The researchers randomly assigned the children to either receive ear tubes and antibiotic ear drops or oral antibiotics when each infection occurred. The children were then followed for two years.

They found that there were no differences in the children in the two groups when it came to how often they had ear infections and how severe the infections were. While the children in the group that didn’t receive ear tubes took more antibiotics, there was no evidence that they developed antibiotic resistance.

The researchers also didn’t find a difference between the groups in the children’s or parents’ quality of life.

However, there was one benefit of the tubes: On average, it took about two months longer for a child to develop an ear infection afterward compared with those who were simply treated with antibiotics.

“Subjecting a young child to the risks of anesthesia and surgery, the possible development of structural changes of the tympanic membrane, blockage of the tube or persistent drainage through the tube for recurrent ear infections, which ordinarily occur less frequently as the child ages, is not something I would recommend in most instances,” lead study author Alejandro Hoberman, MD, director of the Division of General Academic Pediatrics at UPMC Children’s Hospital of Pittsburgh, said in a press release.

Regardless of treatment, the researchers found that all of the children had fewer ear infections with age. Children under a year old had an infection rate that was over two times higher than those who were between 2 and 3 years old.

Ear Infection Symptoms

Acute otitis media is the most common ear infection. It happens when parts of the middle ear are infected and swollen, and fluid is trapped behind the eardrum. This leads to an earache.

Babies and young children aren’t usually old enough to say that they’re in pain, but parents may notice these symptoms:

  • Tugging or pulling at the ear
  • Fussiness and crying
  • Trouble sleeping
  • Fever
  • Fluid draining from the ear
  • Clumsiness or problems with balance
  • Trouble hearing or responding to quiet sounds

Why Ear Infections Are Common In Children

About 25% of children experience at least one ear infection before they’re a year old, while 60% experience the condition by 5 years old.

Children are more likely than adults to get an ear infection for several reasons. One is that their eustachian tubes, which run from the middle ear to the pharynx, are smaller and more level in children, making it difficult for fluid to drain out of the ear.

They also don't have immune systems that are as effective as adults, making it more difficult to fight infections. That can cause the eustachian tubes to become swollen or blocked with mucus due to a cold or other respiratory illness, keeping fluid from draining and leading to an ear infection.

What This Means For You

If your child has regular ear infections, talk to your doctor about your options. They may recommend ear tube surgery, or may simply suggest continuing to use antibiotics to treat each infection. Ultimately, the choice is yours.

Current Ear Infection Treatment Recommendations

The American Academy of Pediatrics (AAP) currently advises treating ear infections with antibiotics like amoxicillin. But, if a child has three infections in six months or four episodes in a year, with one infection in the past six months, the AAP says that doctors “may offer” ear tubes to treat the infections. The AAP also says that doctors should recommend that children receive the pneumococcal conjugate vaccine to try to lower the risk of ear infections.

Ear Tubes Remain a Treatment Option

Doctors don’t recommend changing official guidance just yet.

“These findings surprised me,” Gina Posner, MD, a board-certified pediatrician at MemorialCare Orange Coast Medical Center in California, tells Verywell. “I see lots of kids that have tubes in their ears and they tend to get infections less frequently than others.”

Christopher Grindle, MD, a pediatric otolaryngologist at Connecticut Children’s Medical Center, tells Verywell that some of the children who were originally assigned to be in the antibiotics-only group ended up getting ear tubes because they continued to get ear infections.

He also notes that the study excluded other children who are prone to ear infections, such as those who have cleft palate and certain syndromes. “In some populations, ear tubes have been shown to be beneficial,” he says.

Posner acknowledges that the study didn’t find antibiotic resistance in children who only received the medication, but notes that this was only studied for two years. “It takes a while for antibiotic resistance to develop,” she says. “With kids that don’t have tubes, I have to give them oral antibiotics six or seven times a year. That’s a big concern.”

Grindle recommends that people take away that “nothing is set in stone in the management of ear infections.”

“If appropriately used in certain patients, ear tubes may be the appropriate choice in a particular child and family,” he says. “In other situations, it may not be. But it’s a treatment option.”

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Article Sources
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  1. Hoberman A, Preciado D, Paradise JL, et al. Tympanostomy tubes or medical management for recurrent acute otitis media. N Engl J Med. 2021 May 13;384(19):1789-1799. doi:10.1056/NEJMoa2027278

  2. National Institute on Deafness and Other Communication Disorders. Ear infections in children. Updated May 12, 2017.

  3. AAP News. Understanding otitis media in 2018. Published June 26, 2018.

  4. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis mediaPediatrics. 2013;131(3):e964-e999. doi:10.1542/peds.2012-3488