Dear Alice,

My son has fluid in his ear causing hearing loss. It is not painful. The doctor has said that his Eustachian tubes are blocked by enlarged adenoids, and wants to surgically remove them. We have found that decongestant/antihistamine greatly improves his hearing.

Is there not some way to drain the inner ear without a surgical procedure such as tubes or syringe extraction through the eardrum? How can I reduce apparent swelling in his adenoid/sinus area? We would like the least intrusive method. Could allergies be a problem?

Dear Reader,

Enlarged adenoid glands can sometimes apply pressure on the Eustachian tubes. This inhibits proper drainage of the inner ear, which can lead to discomfort and mild to moderate hearing loss. The angle of the Eustachian tube changes as a child matures, so as children grow they tend to get fewer ear infections, with fewer incidents of hearing loss. The surgical procedure your doctor mentioned – an adenoidectomy, or the surgical removal of the adenoids – is a common Ear, Nose, and Throat (ENT) operation. A scientific review of adenoidectomy in children, however, showed that the benefit to hearing is small.

There are other ways to drain the inner ear or reduce swelling in your son’s adenoid/sinus area besides an adenoidectomy, but some are also surgical procedures. One way is a process which includes the insertion of tympanostomy tubes. Tympanostomy tubes are actually tiny cylinders, made of plastic or metal, that are surgically inserted into the eardrum to ventilate the middle ear. A light general anesthetic is needed in children to perform the procedure. The issue with tubes is that water must be kept out of the ear, so precautions must be taken for bathing and swimming. Another option is a myringotomy, which is where a tiny incision is made in the eardrum and fluid in the middle ear is suctioned out. After the eardrum heals, though, fluid can re-accumulate.

You mentioned giving your son decongestants/antihistamines and seeing improvement in his hearing, and that makes sense. Decongestants constrict blood vessels, which helps open the Eustachian tube by reducing swelling. Antihistamines reduce the body’s inflammatory response to allergies. Therefore, eliminating your son’s exposure to allergens could reduce swelling in the lining of the Eustachian tube and reduce his symptoms. Allergy shots may help or intranasal steroids might reduce inflammation of the mucosal lining of the nose, but will take some time to work if allergies are the problem.

You may want to speak to your pediatrician to get an ENT specialist recommendation for a second opinion. If you haven’t already spoken to an ENT specialist (or if you have and would like a second opinion), s/he can help walk you through the risks and benefits of a surgical procedure such as an adenoidectomy versus other ways to drain the ear or alleviate your son’s symptoms.

Good luck!


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