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,

It’s great that you’re considering all options before making a decision about your son’s health. The surgical procedure you mentioned — an adenoidectomy, or the surgical removal of the adenoids — is a common ear, nose, and throat (ENT) operation, but a scientific review among children showed that the benefit to hearing is small. In addition to an adenoidectomy, procedures such as inserting a tympanostomy tube or continuing to use antihistamines may provide some relief. In any case, if you haven't already, it might be helpful to consult with an ENT specialist to determine the most appropriate course of action for your son.

When children are young, their Eustachian tubes (tubes that connect the middle ear to the throat) tend to be more narrow and horizontal, which can be a breeding ground for ear infections. This may be further impacted by enlarged adenoids that put pressure on the Eustachian tubes and inhibit proper drainage of the inner ear, leading to mild to moderate hearing loss, discomfort, and ear infections. As a child grows the Eustachian tube develops and adenoids tend to shrink, making ear infections and hearing loss due to infection less common among adults. That being said, it’s helpful to be aware of the risk factors for ear infections, since they coincide with blocked Eustachian tubes:

  • Age: Children between the ages of six months and two years are more susceptible to ear infections because of the shape and size of their Eustachian tubes and weaker immune systems.
  • Group child care: Children cared for in group settings are more likely to be exposed to germs from other kids, which could cause ear infections.
  • Infant feeding: Babies who are bottle fed, especially while lying down, tend to have more ear infections than do babies who are breastfed. Breast milk contains antibodies that may help reduce the risk of infection.
  • Seasonal factors: Ear infections are more prevalent during flu and allergy seasons as the nasal passages may be swollen.
  • Poor air quality: Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.

List adapted from Mayo Clinic.

Given the common concurrence of blocked Eustachian tubes and ear infections, limiting exposure to secondhand smoke, washing hands often, and keeping your son’s vaccines up to date are all good practices to mitigate the risks of infection.

You mentioned seeing improvements in your son’s hearing with use of decongestants and antihistamines. Decongestants constrict blood vessels, which helps open the Eustachian tubes by reducing swelling, and antihistamines reduce the body’s inflammatory response to allergies. If you found this strategy to be effective, you might also try limiting your son’s exposure to allergens to reduce swelling in the lining of the Eustachian tube and reduce his symptoms. Allergy shots or intranasal steroids might help but will take some time to work if allergies are the problem.

In addition to the adenoidectomy, there are other procedures you might explore to drain the inner ear or reduce swelling in your son’s sinus area, but some are also surgical procedures. One alternative is the myringotomy, which is where a tiny incision is made in the eardrum and fluid in the middle ear is suctioned out. It’s good to note, however, that fluid can re-accumulate after the eardrum heals. Additionally, in some instances, during a myringotomy tubes called tympanostomy tubes will be inserted. After administering a light anesthetic, the health care provider inserts small plastic or metal cylinders into the child’s eardrum to ventilate the middle ear. This option requires that water doesn’t enter the ear, so precautions must be taken when it comes to bathing and swimming. Some are intended to be in place for about six months to a year and can fall out on their own, while others are intended to stay in place longer and need surgical removal.

There are many options to sift through, so speaking with an ENT specialist may be helpful. They 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. If they're making recommendations that you aren't comfortable with, you may want to seek a second opinion to learn more about other options.

Here’s to some earned ear relief for your son,

Alice!

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