Tubes in the Ears: Do they Help, Do they Hurt, What's the Long-term Impact?

Tubes in the Ears:  Do they Help, Do they Hurt, What's the Long-term Impact?

Nearly every child will have at least one ear infection, and about 30-40% of children have recurrent ear infections.  

For those children who have many, many ear infections, the choice of whether to place tubes in the eardrums to improve drainage and cut down on the number of ear infections is an option that frequently comes up.

In the February 2014 issue of Pediatrics, the question of how the tubes work was reviewed.  Over 40 research papers that did a quality job of assessing what the tubes do and do not do were reviewed.

Several themes emerged from this comprehensive review.

Placing tubes in the eardrums does reduce the number of ear infections a child has

The studies were in agreement that if you have tubes in your eardrums, you will have fewer infections.

This supports what we consider the best reason to place these tubes: if the pain of constant or recurring ear infections is too much to bear, ear tubes will help and make sense to have.

Placing tubes in the eardrums has no impact on a child's development of language, cognitive, or academic skills.

Much has been made of the fact that while you have an ear infection, or even just fluid in the ear, your hearing is not as good.  This of course makes sense, put your thumbs in your ears and your hearing gets dramatically worse.  The question is, if your hearing is reduced for a few months or years in early childhood, will that have an impact on your language development?     It is well known that when the ear infection heals and the fluid clears, hearing returns to normal, so the impact of infection or fluid in the ear is always temporary.

What this careful review found was if you took a group of kids with lots of ear infections or fluid and some got tubes and some did not, there was no difference in the cognitive, language, or academic function of the two groups over time.  

So yes, if you have lots of fluid in your ears when quite young, you may not learn as many words as someone without fluid, at the time the fluid is present.  But if you check in some years later, well after the fluid has dried up, say around 7-10 years of age or beyond, the vocabulary, language level, cognitive level, and academic performance level is the same whether you had fluid or not.

This finding supports the notion that the impact of lower hearing while fluid is present disappears once the fluid clears.

Placement of tubes in the eardrums increases the chance that there will be drainage and/or scarring in the ears

The studies also found that kids who got tubes in the eardrums experienced an increase chance of draining fluid from the ear and later on, of scarring on the drum.

BOTTOM LINES

• Ear infections are a very common event in childhood, and many children get many of them.
• Placing tubes in the ears can offer real relief from very frequent, painful ear infections.
• Placing tubes in the ears may offer no change in ultimate levels of language, cognitive, or academic performance
• Placing tubes in the ears does increase the chance of scarring of the eardrum and drainage from it.
• Our recommendation is to place tubes in the ears mainly for relief of excessive and relentless pain, not simply in response to a certain number of ear infections.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

How Long do Cold Symptoms Last?

How Long do Cold Symptoms Last?

Everyone gets colds, everyone.   

And we all have a sense of how long we think it's normal for them to last, but do we really know?

Well, now we do.   A major study was published by scientists from Oxford and Bristol in the UK and from Portland, OR in the US.   http://www.bmj.com/content/347/bmj.f7027.pdf%2Bhtml

In this paper, the medical literature was examined and 48 studies identified that gave good data on how long a runny nose, a cough, a sore throat, and an earache last when you get a cold or the flu.

What follows is what they found out.  But first a word on how they reported the results.

The Technique of Describing How long the Symptom Lasts

What they did was take a group of kids with colds and ask two questions, for each symptom:

1. How many days need to go by for half the kids to no longer have that symptom?
2. How many days need to go by for nearly all (90% to be exact) of the kids to no longer have that symptom?

For all the results, keep in mind the number of days is how long it took otherwise healthy kids with colds to get better.   This information does not include any children who developed complications such as pneumonia or asthma, just simple colds that healed without any complications or lasting problems.

The Results:  How long does each Symptom Last?

So here we go, this is how long each of these 4 symptoms typically last in a simple, uncomplicated cold that heals completely without any complication:

Runny Nose, Feeling Sick

50% of kids stopped having a runny nose or feeling sick by Day 10 of the cold

90% of kids stopped having a runny nose or feeling sick by Day 16 of the cold

Range: Looking at all the kids, the range of how long kids had a runny nose or felt sick was 4-16 days.

Sore Throat

This symptom did not have enough people studies to give 50 and 90 percentile duration numbers, but the study did cite that:

Looking at all the kids, sore throats lasted in a range from 2-6.7 days.

Interestingly, how long you were suffering from a sore throat was the same if you had a cold or strep throat.

Fever

Again, not enough kids studied to give exact percentile ranges, but the following trends were reported:

Most typically, fever lasted 2-3 days (44% of kids with a cold)

But fever often lasted more than 3 days (28% of kids with a cold)

Many kids were lucky to have a fever for less than a day (17% of kids with a cold)

And a few had a fever for the 1-2 day  duration (11% of kids with a cold)

Ear Infection

50% of kids stopped having an earache by Day 3 of the cold

90% of kids stopped having an earache by Day 7-8 of the cold

Range: Looking at all the kids, the range of how long kids had an earache was 1/2-9 days.

Croup

50% of kids stopped having croupy cough by Day 1 of the illness

80% of kids stopped having croupy cough by Day 2 of the illness

Range: Looking at all the kids, the range of how long kids had a croupy cough was 1-3 days.

COUGH

50% of kids stopped having a cough by Day 10 of the cold

90% of kids stopped having a cough by Day 25 of the cold

Range: Looking at all the kids, the range of how long kids had a cough was 1-25 days.

What these Observations Mean

This was a very, very interesting study, finally answering a question we get asked as much as any other question:

How long does a cold symptom last, and if the symptom is still present does that mean it's no longer just a cold, but some complication has developed?

Now we have the answers.

As noted above, the most striking finding for me was that a child with a plain old cold, no complications, who is going to be fine, can easily have a cough for 25 days!

This is what we see, it does fit with actual experience, but how incredible that a simple cold can make you cough for a month, easily.   And it fits with our experience that the fever, ear ache, sore throat, runny nose, and even feeling sick can all go away long before the cough ceases.

Bottom Line

• The one day cold is a great hope, but rarely seen.
• Colds tend to last 1-2 weeks.
• The cough from a cold is the symptom that takes the longest to heal, and typically can go on for a month, even if no complications are present.
• Overall, colds cause a lot more suffering than we imagine, but they do heal, they ultimately cause no lasting harm or damage, it takes a long time to heal, but we do heal, and completely.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Time to Choose a Pharmacy that Does not Sell Tobacco

Time to Choose a Pharmacy that Does not Sell Tobacco 

Normally we do not endorse any particular store or brand, but the CVS drugstores announced a decision on February 5, 2014 that truly deserves our admiration and calls for our support.

For many years, I have been rather amazed at the fact that at the back of all the major pharmacies, life-giving medications are made available for a full range of serious medical conditions.  The pharmacies are places where lives are saved and improved.

But at the front of every one of these stores, a huge rack of goods are sold that kill more people than any single disease, tobacco.  And on February 5, 2014, the CVS corporation decided it would empty all its stores of all tobacco products this year.  This is the first major national pharmacy chain to take this action.   It will cost this company $2 billion in revenue every year.

I am sure there are reasons it took this step that make good business sense, there are no illusions about the extent of this altruism.  But the point is that they have taken this step.

An American pharmacy chain has decided to no longer sell any tobacco products.

This is so important, because tobacco alone causes 1/3 of all cancer.   About 2 million Americans die every year, and tobacco causes about 400,000 of those 2 million deaths.

Of course, not all death is preventable, but about 1 million deaths a year don’t need to happen that year, and tobacco is the cause of 40% of those needless deaths.

It has long seemed most cruel that we sell tobacco, knowing how much suffering, illness, and death it causes.   So it is very heartening to see the medical world really step up to eliminate tobacco from our lives.  Most hospitals are completely tobacco free campuses.

And now, CVS will no longer sell it.

With this step, we now recommend that if you can choose where to get your prescriptions, you do them all at a CVS, until the other chains (e.g., Walgreen’s, Rite-Aide), and big box store pharmacies (e.g., WalMart, Target) follow suit and also stop selling the deadly tobacco products.

Today, I happened to need a photo frame, and changed where I went to be sure it was a CVS store.  I mentioned to the staff present that I thought the decision to end sales of all tobacco products was a powerful and life-giving decision, and that I would be recommending that all pharmacy business go to CVS until the others stop selling tobacco.

The staff were, justifiably, quite proud.

Bottom Line:

• Tobacco causes nearly half of all the preventable deaths in the US each year, and fully 1/3 of all cancer.
• On February 5, 2014, CVS made history, committing at great cost to end sales of all tobacco products by October.
• Our recommendation is that all pharmacy commerce be now directed to only stores that have committed to stop all sales of all tobacco products.  At this time that is only CVS.
• Let your pharmacy know if you hope that they will no longer sell tobacco, and if you plan to only purchase goods at pharmacies committed to ceasing all sales of all tobacco products.
• This is an issue beyond politics and the varying fads in health.  Tobacco is a very serious, very addictive, and very deadly product.  It is very powerful to be able to help all our pharmacies to follow the lead of CVS.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.