Ear tubes are often turned to as a solution to persistent fluid in the ear from ear infections, because the fluid buildup can cause hearing loss. However, there are questions about the effectiveness of the ear tubes. In addition, the ear tubes have surgical risks, including the risk of methicillin-resistant staphylococcus aureus (MRSA), which is resistant to many antibiotics.
When to Use Ear Tubes
Why are ear tubes (tympanostomy tubes) even needed to begin with? A young child has a shorter eustachian tube, which makes him or her more prone to ear infections. This eustachian tube does not lengthen until about age three or four.
The American Academy of Pediatrics has guidelines on managing childhood ear infections. Ear infections often resolve independently within a few months. The Academy recommends that a child who has otitis media with effusion (OME, an ear infection with persistent middle ear fluid) for three months or longer be evaluated for hearing loss.
The Academy has recommendations on what to do based on the severity of the hearing loss due to OME. Then, if hearing loss is greater than or equal to 40 decibels (moderate or greater) is found, surgery (ear tubes) are recommended because hearing loss at that level or greater is known to impact "speech, language, and academic performance." For less severe hearing loss of 21 to 39 decibels, the Academy recommends monitoring the hearing loss because mild hearing loss is also known to have an impact. When the hearing is normal but the OME persists, repeating the hearing tests three to six months later is recommended.
Effectiveness of Ear Tubes
How effective are ear tubes, and is three months long enough to wait before getting tubes? A study, cited in Child Health Alert, was done in 1991 of 429 children under age three who received tubes either right away, or up to nine months later. This study checked on the children's development at ages three, four, and six years and found no difference in their development. A follow-up study was done when the children were nine to eleven years old, and again, no differences were found in 48 measures of development, including auditory tests. The authors of the study concluded that instead of getting ear tubes after just three months of persistent infection, it would be better to wait and watch for at least six months for both ears, and at least nine months for one ear.
A similar study, reported in Archives of Disease in Childhood, was done of 395 children under age three who had persistent middle ear fluid for at least 90 days in both ears, or at least 135 days in one ear. These children also received ear tubes either promptly or up to nine months later. They were checked at age six for developmental differences between the "prompt" group and the "delayed" group, and none were found.
Risks of Ear Tubes
Just like any surgery, ear tubes have associated risks of infection, including the risk of MRSA. The Centers for Disease Control and Prevention (CDC) defines a surgical site infection as one that occurs within a year of having a foreign body, such as ear tubes, implanted.
How frequently does MRSA occur following ear tube placement? Apparently not that often. A December 2000 Archives Of Otolaryngology Head & Neck Surgery article reported that from December 1998 to January 2000, eight children who received ear tubes developed MRSA. The authors said this was a "0.2% incidence" for MRSA, but did not state what the total number of children who received ear tubes was. However, the authors also said this was an "extremely low" incidence of MRSA.
Furthermore, based on an article that appeared in the August 2009 issue of the Journal of Otolaryngology-Head & Neck Surgery, MRSA does not appear to be that common in cultures of ear infections whether or not ear tubes are involved. A large study of more than 400 ear cultures spanning 2002 to 2006 found that MRSA was present in just 38 (8.5%) of the ear cultures. In addition, a review of past studies came across MRSA in just 7% of the cultures of ear infections.
It is also possible, as suggested by The Journal of Laryngology & Otology, that the type of material used for the ear tubes may make a difference. A study compared three sets each of vancomycin-coated silicone tubes, commercial silver oxide coated silicone tubes, and uncoated tympanostomy tubes. (These tubes were not implanted in any patients.) Researchers checked for formation of MRSA biofilm, and found that the vancomycin-coated tubes were "virtually devoid" of MRSA biofilm. The results of this study supports the idea of ear tube material being a factor, but it has not been replicated in real life.
Parents' Frustrations with MRSA in the Ear
There is no evidence to support the idea that ear tubes cause MRSA. In fact, it may be present before the insertion of ear tubes, because MRSA is acquired in both the community and in hospitals. However, MRSA in the ear is apparently difficult to get rid of. Many frustrated parents have posted to the About.com Deafness blog post, "MRSA Infection in the Ear?" about their struggles to eliminate MRSA from their children's ears after getting ear tubes.
How then can MRSA in the ear be treated successfully? One 2005 report in the Archives Of Otolaryngology Head & Neck Surgery stated that six children with MRSA in the ear were not responding to the usual oral antibiotics. All six were successfully treated with oral trimethoprim-sulfamethoxazole and ear drops (gentamicin sulfate or polymyxin B sulfate-neomycin sulfate-hydrocortisone [Cortisporin]). Most MRSA has been found to be susceptible to trimethoprin-sulfamethoxazole.