David Vernick, M.D. is assistant clinical professor of otology and laryngology at Harvard Medical School and interim chief of the Division of Otology and Laryngology at Beth Israel Deaconess Medical Center.

Question:

My son is 28 months old and has had seven ear infections. I have heard about putting tubes in the ears for this, but his doctor says we should wait. After how many ear infections should we wait before tubes should be implanted?

Answer:

Children who have frequent ear infections or persistent middle ear fluid can be treated with "tubes." Ventilation tubes are implanted through a hole in the ear drum (myringotomy). The tubes ventilate the middle ear and drain any fluid.

In many children, the Eustachian tube (a connection between the middle ear and the back of the nose) does not work effectively during early growth. When this is the case, fluid can build up in the middle ear. Persistent fluid can lead to recurring ear infections.

Draining the fluid by inserting ventilation tubes breaks the cycle and can stop the infections. Tubes usually stay in about a year. Many times a repeat procedure is not necessary.

The criteria for putting tubes in vary. Usually, you need one or more of the following:

• Five or more ear infections in a year

• Persistent middle ear fluid for three months or more

• A persistent ear infection that does not go away with antibiotic use

In practical terms, doctors and parents consider how severe the infections are, how symptomatic the child is and whether or not there are associated problems such as a speech and language delay or developmental delays.

Another consideration is whether there are any changes in the eardrum and any associated hearing problems.

As part of the evaluation, an ear, nose and throat doctor (ENT or otolaryngologist) will review these issues and provide guidance on if and when to proceed with tubes.