researchers find no benefit to tubes over antibiotics for

Researchers Find No Benefit to Tubes Over Antibiotics for Recurrent Ear InfectionsPublished on Library Services for the Deaf and Hard ofHearing (https://tndeaflibrary.nashville.gov)

Researchers Find No Benefit to Tubes Over Antibiotics forRecurrent Ear Infections Source: Hearing HealthMatters: https://hearinghealthmatters.org/hearingnewswatch/2021/tubes-ear-antibiotics/ [1]Posted: May 28, 2021

PITTSBURGH, PENNSYLVANIA – There is no long-term benefit to surgically placing tympanostomytubes in a young child’s ears to reduce the rate of recurrent ear infections [2] during the ensuing twoyears compared with giving oral antibiotics to treat ear infections, a randomized trial led by UPMCChildren’s Hospital of Pittsburgh [3] and University of Pittsburgh [4] pediatrician-scientistsdetermined.

The trial results, published this month in the New England Journal of Medicine [5], are among the firstsince the pneumococcal vaccine was added to pediatric vaccination schedules [6], providing updatedevidence that may help shape pediatric guidelines on treating recurrent ear infections. Importantly,despite their greater use of antibiotics, the trial found no evidence of increased bacterial resistanceamong children in the medical-management group.

“Subjecting a young child to the risks of anesthesia and surgery, the possible development ofstructural changes of the tympanic membrane, blockage of the tube or persistent drainage throughthe tube for recurrent ear infections, which ordinarily occur less frequently as the child ages, is notsomething I would recommend in most instances,” said lead author Alejandro Hoberman, M.D.,director of the Division of General Academic Pediatrics at UPMC Children’s Hospital [7] and the JackL. Paradise Endowed Professor of Pediatric Research at Pitt’s School of Medicine [8].

“We used to often recommend tubes to reduce the rate of ear infections, but in our study,episodic antibiotic treatment worked just as well for most children,” he said. “Anothertheoretical reason to resort to tubes is to use topical ear drops rather than systemic oralantibiotics in subsequent infections in the hope of preventing the development of bacterialresistance, but in this trial, we did not find increased resistance with oral antibiotic use. So,for most children with recurrent ear infections, why undergo the risks, cost and nuisance ofsurgery?”

–Alejandro Hoberman, M.D.

Childhood Ear Infections

Next to the common cold, ear infections are the most frequently diagnosed illness in U.S. children.Ear infections can be painful, force lost time at work and school, and may cause hearingloss. Tympanostomy tube placement [9], which is a surgical procedure to insert tiny tubes into achild’s eardrums to prevent the accumulation of fluid, is the most common operation performed onchildren after the newborn period.

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Hoberman and his team enrolled 250 children ages 6 to 35 months of age at UPMC Children’sHospital, Children’s National Medical Center [10] in Washington, D.C., and Kentucky Pediatric andAdult Research [11] in Bardstown, Ky. All of the children had had medically verified recurrent earinfections and had received the pneumococcal conjugate vaccine. They were randomly assigned toreceive “medical management,” which involved receiving oral antibiotics at the time of earinfections, or the surgical insertion of tubes and antibiotic ear drops. The children were followed fortwo years.

Overall, there were no differences between children in the two groups when it came to the rate orseverity of ear infections. And, though the children in the medical management group received moreantibiotics, there also was no evidence of increased antimicrobial resistance in samples taken fromthe children. The trial also didn’t find any difference between the two groups in the children’s qualityof life or in the effect of the children’s illness on parents’ quality of life.

One short-term benefit of placing tympanostomy tubes was that, on average, it took about twomonths longer for a child to develop a first ear infection after tubes were placed, compared withchildren whose ear infections were managed with antibiotics.

Another finding of the trial was that the rate of ear infections among children in both groupsfell with increasing age. The rate of infections was 2.6 times higher in children youngerthan 1 year, compared with the oldest children in the trial, those between 2 and 3 years,regardless of whether they received medical management or tube insertion.

“Most children outgrow ear infections as the Eustachian tube, which connects the middle-ear withthe back of the throat, works better,” Hoberman said. “Previous studies of tubes were conductedbefore children were universally immunized with pneumococcal conjugate vaccine, which also hasreduced the likelihood of recurrent ear infections. It’s important to recognize that most childrenoutgrow ear infections as they grow older. However, we must appreciate that for the relatively fewchildren who continue to meet criteria for recurrent ear infections—three in six months or four in oneyear—after having met those criteria initially, placement of tympanostomy tubes may well bebeneficial.”

Additional study authors are Diego Preciado, M.D., Ph.D., and Daniel E. Felton, M.D., both ofChildren’s National Medical Center; Jack L. Paradise, M.D., David H. Chi, M.D., MaryAnn Haralam,M.S.N., C.R.N.P., Diana H. Kearney, R.N., C.C.R.C., Sonika Bhatnagar, M.D., M.P.H., Gysella B. MuñizPujalt, M.D., Timothy R. Shope, M.D., M.P.H., Judith M. Martin, M.D., Marcia Kurs-Lasky, M.S., Hui Liu,M.S., Kristin Yahner, M.S., Jong-Hyeon Jeong, Ph.D., Jennifer P. Nagg, R.N., Joseph E. Dohar, M.D., andNader Shaikh, M.D., M.P.H., all of Pitt; Norman L. Cohen, M.D., and Brian Czervionke, M.D., bothof UPMC Children’s Community Pediatrics [12]; and Stan L. Block, M.D., of Kentucky Pediatric andAdult Research.

The research was funded by National Institute on Deafness and Other Communication Disorders[13] grant NCT02567825, University of Pittsburgh Clinical and Translational Science [14] awardsUL1RR024153 and UL1TR000005, and the National Center for Research Resources, now atthe National Center for Advancing Translational Sciences [15].

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Source: UPMC [16]

Source URL: https://tndeaflibrary.nashville.gov/announcements/researchers-find-no-benefit-to-tubes-over-antibiotics-for-recurrent-ear-infections

Links[1] https://hearinghealthmatters.org/hearingnewswatch/2021/tubes-ear-antibiotics/[2] https://www.chp.edu/health-care-professionals/podcast/ears-alejandro-hoberman[3] https://www.chp.edu/[4] https://www.pitt.edu/[5] https://www.nejm.org/[6] https://www.cdc.gov/vaccines/vpd/pneumo/hcp/recommendations.html[7] https://www.chp.edu/our-services/general-academic-pediatrics[8] https://www.medschool.pitt.edu/[9] https://www.chp.edu/our-services/ent/patient-procedures/bilateral-myringotomy[10] https://childrensnational.org/[11] https://kpar.us/[12] https://www.childrenspeds.com/[13] https://www.nidcd.nih.gov/[14] https://ctsi.pitt.edu/[15] https://ncats.nih.gov/[16] https://www.upmc.com/media/news/051221-hoberman-ear-tubes-nejm

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