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TOO MANY TONSILLECTOMIES AND EAR TUBES

A study in the New England Journal of Medicine shows that implanting ear tubes does not help improve speech and hearing or learning development in young children. Your Eustachian tube leads from your middle ear to the back of your throat. Fluid travels from the middle ear behind your ear drum down the Eustachian tube into your throat.

If you have swelling in the back of your throat, it closes the Eustachian tube to cause fluid to collect in the middle ear and perhaps block hearing and interfere with a child's development. The middle ear is separated from the outside by a tough tympanic membrane. Ear, nose and throat surgeons often cut a hole into the tympanic membrane and insert a tube and leave it in the tympanic membrane. Then, when fluid cannot pass down the Eustachian tube, it accumulates in the middle ear. Then the ear tube allows ear fluid to pass to the outside through your ear. While the theory is fine, this study shows that placing ear tubes do not help a chid's development.

Dr. Jack Paradise, of the University of Pittsburgh, reports that surgically removing tonsils and adenoids has little, if any, effect in preventing recurrences of ear infections (JAMA September 7, 1999.). Incredibly, doctors still remove more than 400,000 tonsils each year. Tonsils and adenoids are lymphatic tissue. Almost never should doctors remove tonsils before age 4, because prior to age 4, they are a major supplier of the cells and proteins that help to protect you from being infected with viruses and bacteria. However after that, the tonsils and adenoids are less important in protecting you from infections and removing them does not appear to cause harm.

A study in Clinical Otolaryngology (2000, Vol 25, Iss 5, pp 428-430) shows that after waiting for surgery for 9 months, almost 30 percent of children scheduled for surgery got better so they didn't need the surgery.

This month, an article in International Journal of Pediatric Otorhinolaryngology, (2001, Vol 58, Iss 1) showed that the Epstein-Barr Virus (EBV) that causes mononucleosis infects almost all children and that the virus can persist in the tonsils of children who have had mono. Most people who have mono are never diagnosed as having that disease. Thirty percent of the tonsils removed at surgery from children with recurrent tonsilitis are infected with the Epstein Barr virus.

In the pediatric journal, Acta Paedriactica (2001, Vol 90, Iss 2, pp 126-129), researchers from Sweden found chlamydia bacteria in almost all the tonsils that were removed from children with chronic recurrent respiratory infections. Chlamydia pneumoniae is a common cause of respiratory infections in children and that bacteria remains in a child's throat forever or until it is killed by the appropriate antibiotic. This may mean that chronic sore throats in children should be treated with the antibiotics: Zithromax, Biaxin or Dynabec and tonsils be removed only if the treatment fails.

The main reasons to remove tonsils are blockage of the flow of air to a child's lungs and when an abscess forms. Even then, doctors can often avoid surgery because tonsils reach their maximum size at ages eight to ten and then become relatively smaller with each passing year. However, tonsils are usually removed when a child has sleep apnea, a condition in which he stops breathing intermittently during sleep; severe snoring or significant difficulty swallowing.

New England Journal of Medicine, April 19, 2001

Checked 8/9/05

May 31st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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