Myringotomy and Other Big, Fancy Words

It's 2 a.m. and I am in bed, awake. I have been tossing and turning in a cold sweat for what feels like an eternity, waking up every thirty minutes, at best. In only a few hours, I'll be getting up to begin a day that I have been dreading for months.

Tomorrow, my baby gets ear tubes.

But ear tube surgery is not such a big deal, right? According to two otolaryngology (ear, nose and throat) specialists and everyone else I have asked who has personal experience with ear tubes, it is one of the most simple, routine, low-risk surgeries one can have. And yet I find myself lying here wide awake, mere hours before my little guy's surgery, and all I can think is, "What if this is a huge mistake?"

Risks, Benefits, Alternatives

A very sad little boy with an ear infection (Healthtree.com)

Let me back up. Before his first birthday, my little boy had already had approximately 8 ear infections. I say "approximately" because we honestly lost count a loooong time ago. In actuality, he probably had more - especially if you separately count each ear in a "double ear infection" (when both ears are infected simultaneously). To say we were at our wits end would be putting it lightly. Just when we would get over one infection, the next would make its appearance. The symptoms were roughly the same each time, although they changed some as little man grew bigger and began communicating with us in different ways. The first tip-off for my husband and me was always the inconsolable crankiness. Then came the clingy behavior - we risked a huge temper tantrum if we put him down for even a second. Then the fever would appear. Doctors appointments became a formality, only necessary for the inevitable antibiotic prescription we would receive. Once I joked with my son's pediatrician that we should just get our own otoscope (the tool used to examine the ear) and save ourselves a copay and a trip to her office. She replied that we didn't even need it, as we always seemed to know when he had an infection, even without her looking.

With this pattern of recurring ear infections, the subject of tubes had come up more than once. I was determined, though, to try some other options before resorting to surgery. It just seemed so...drastic, so extreme. I did some research to try and find alternative ways to combat the infections. We tried a combination ear drop made of echinacea and goldenseal. We tried another drop - a garlic oil that smelled to high heaven and imparted a permanent stench to anything it touched. We gave him a steady dose of probiotics to beef up his immune system, particularly when he had a stuffy nose or cough, since ear infections are "secondary infections," often appearing in conjunction with a cold or flu infection. We used a humidifier in his room, and used a saline solution and nasal aspirator to clear his nose twice a day. I won't say we tried everything, because I know that we didn't. We did not take little man to a chiropractor, and we never tried homeopathic remedies. Still, I felt we gave it a good shot, and we managed to stave off infections for a good 5 months - from November through March he did not get a single one. It seemed like we were doing something right, and we were encouraged. By the time April rolled around, though, the old pattern had returned. Little man got four ear infections and bronchiolitis all back to back, and we had finally had enough.

I started looking into what would be involved with an ear tube surgery, known to doctors as a "myringotomy." It seemed like a relatively minor procedure, other than the use of anesthesia (which can carry its own risks). But then I started reading articles like this New York Times article from 2006. The article discusses the many drawbacks to myringotomy, including the potential for future, additional surgeries; compares the risk of hearing loss and developmental delays for children with tubes versus those without; and hypothesizes on the affect of immunization on frequency of ear tube surgery. Ear tube surgeries are an overused solution, according to those quoted in the article, and a preventive approach to antibiotic use (dosing a child with antibiotics whenever they get a cold) is suggested as an alternative (a suggestion that is later noted to be outdated).

What I gathered from this discussion is antibiotic treatment - one of only two available remedies for chronic ear infections, (the other being ear tube surgery) - is the lesser evil in this particular situation. Although I agree that ear tube surgery may be overused, the fact remains that antibiotics are, as well. I pondered our choices, considering the effects of each option - short term, long term, individual and societal. Here's what I came up with:

	PROS	CONS
EAR TUBE SURGERY (i.e. Myringotomy)	Reduces frequency and severity of ear infections  Potential for improved sleeping, and overall health and well-being  Avoidance of antibiotics and risks associated with them (antibiotic resistance, diarrhea, illness and disease later in life, more disease risk, etc.)	Risk of scarring and hearing loss Use of anesthesia and risk associated with it  Potential for needing future surgeries if tubes fall out early  May be an extreme and/or overused solution, depending on circumstances
EPISODIC ANTIBIOTIC TREATMENT	Avoidance of surgery and anesthesia  Slightly decreased duration of  ear infection	Contributing to larger scale antibiotic resistance  Continued ear infections mean risk for hearing loss and developmental delays  Creates additional problems, such as diarrhea
DOING NOTHING (i.e. “Watchful Waiting")	Child may simply “outgrow” the problem	Risk for hearing loss and developmental delays  Untreated infection could spread

Comparing all of these options side by side helped me to see that, for us, the overall benefits of surgery outweighed the risks. We bit the bullet and went for it.

Aaaand, the results... (drum roll, please!)

So, you may be wondering how our little guy has fared since his surgery. It has now been two weeks since he had his tubes put in, and we have seen some positive signs that it was, indeed, the right choice for him. Within a week of the surgery, he was making some final leaps toward several developmental milestones that had be in the works for some time - he began pointing with just one finger rather than with his whole hand; he said "baby," his first word that did not consist of the same repeated sound (i.e. "mama," "dada," "baba"); he began letting us hold his hands while he tried to walk - something he would never let us do before. Are these things related to his surgery? Who knows. What I do know is that my baby is feeling better, a benefit that far outweighs what minimal risk I was able to associate with the scary-sounding "myringotomy" procedure.

I surprised myself, truth be told. I had been determined to avoid surgery unless it was truly our only remaining option. But what it came down to, really, was what was going to make life better - easier, more peaceful, more predictable - for my family and myself. The choice might not be the same for someone else. Ultimately, I tried to use an approach that served me well during my pregnancy and continues to do so as I navigate my way through the wild world of parenting:  get as much information as possible when making a decision, and then...let it go, trusting that I've done what's right for us.