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Rose Godfrey, MA, CCC

Your question:
At my son's two-year check up, the pediatrician noticed that my son is not talking much. He recommended putting tubes in his ears to help him hear better. I think he hears just fine, and I don't know why tubes would make him talk more.

The expert answers:
If your son's pediatrician is talking tubes in the ears, it is probably because your child has a history of chronic otitis media, more commonly known as ear infection. When a child has multiple ear infections, fluid can accumulate in the middle ear causing short-term hearing loss and pain.

When a child has a fluctuating hearing loss, the quality of sound perception can change from day to day, week to week. When there is no fluid in the middle ear, your son hears things as well as you do, but when he his ears are filled with fluid, the sounds are distorted.

Precision is important when it comes to learning to speak clearly. An ear infection acts as a kind of "earplug" to a child who is trying to sort out a vast array of sound combinations. When fluid is present for months at a time, your child is missing out on hearing sounds clearly all that time.

Children have more ear infections than adults do because of their anatomy. There is a tube, called the Eustachian tube, that connects the middle ear to the back of the throat. When you go up or down in elevation, you have probably had the sensation of your ears "popping." That sensation is actually your Eustachian tube opening and allowing the pressure in your middle ear equalize with the air pressure around you.

In a child, the Eustachian tube is horizontal. As the child grows and matures, the Eustachian tube begins to tilt downward so that any excess fluid in the middle ear naturally drains into the back of the throat. Sometimes, the Eustachian tube opening in the back of the throat can be blocked by enlarged adenoids. In this case, the doctor may recommend a tonsillectomy and adenoidectomy to remove the blockage.

Inserting pressure equalization (PE) tubes is a relatively simple procedure in which the physician uses a surgical microscope and makes very small incision in the child's eardrum and inserts very small tube in that hole. PE tubes allow any excess fluid to drain out from the child's middle ear into the outer ear canal. This also helps to equalize the pressure in the middle ear. When a child has PE tubes, there may be discharge from the ear as the fluid drains out.

What are the risks?
The risks associated with PE tube placement are minimal. In rare cases, hearing can worsen. In a very small percentage of cases, the eardrum can fail to close after the tubes come out, a condition that can be repaired easily. The benefits to tube placement nearly always include increased hearing acuity. In addition, equalization of pressure and reduction of middle ear fluid can dramatically relieve ear pain and reduce the risk of further infection in the hearing mechanism.

PE tubes usually stay in for several months. Sometimes they are removed by the doctor, but quite often they fall out into the outer ear canal on their own over time. If the tubes fall out too soon, or if a child continues to have ear infections after the tubes are removed, it may be necessary to put a new set in.

In general, PE tubes are hassle free, but you should check with your doctor first to find out any special precautions for bathing or swimming. In most cases, ear plugs will protect the middle ear when your child is going to be getting wet.

Children who have PE tubes installed usually enjoy a rapid spurt of language growth very soon after the tubes start doing their job.PregnancyAndBaby.com

Tags: hearing talking tubes


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