Does my daughter really need surgery?

December 31, 2005 8:33 PM

Help my 7-year-old daughter hear me. (Medical, not behavioral issue)

My oldest daughter (just turned 7) gets a stuffy nose and sinus congestion along with mild ear infections fairly frequently. Apart from the discomfort, her ears frequently get clogged and consequently she has a hard time hearing, a condition known as 'secretory otitis media' or, more commonly, 'glue ear' (from here.) We took her to a pediatrician about 6 months ago and he diagnosed her with swollen adenoids (hence the glue ear link.) His advice was to have an adenoidectomy performed. This terrifies me.

I hate the idea of subjecting my daughter to a surgical procedure that requires general anesthetic and the small but real risk that she might not wake up. I also hate the idea of her being subjected to the normal misunderstandings that come of being hearing-impaired. I remember having a perpetually stuffy nose when I was young, and I imagine that I had similarly swollen adenoids which self-resolved; I can hear fine now. So, what do I do? Are there alternative therapies out there that I can't find? Do we just wait it out and resign ourselves to raising our voices when we talk to her until she matures past the condition? Is there a chance that she might not mature past the condition, and do we risk irreparable harm by inaction?

I want so much to be the best daddy ever, and it's things like this that tear me apart.

Oh, and I do intend to get a second opinion, and ask these questions of another pediatrician. The trouble is, if the pediatrician is also the surgeon, I imagine it makes his life easier (and his paycheck larger) to recommend surgery instead of other, less-invasive therapies, if he's even aware they exist. I'm hoping there are other parents out there with similar experience that can offer advice.

Oh, and happy New Year, everyone!

posted by ZakDaddy to health & fitness (32 comments total)

My brother had adenoid surgery when he was about 6 or 7, I guess. He's two years younger than me, and all I really remember about it was that he was supposed to have plastic tubes come out of his ears or mouth or something. (I guess they put in tubes to hold things open, and they just get pushed out?)
Anyway, he survived and went on to become a relatively well-respected professor at SUNY.
IANAD, but repeated ear infections are no fun, and don't they leave scar tissue or other hearing-unfriendly gunk?
posted by spacewrench at 8:50 PM on December 31, 2005

I had frequent ear infections as a child and had my adenoids removed and also had tubes put in my ears. In my case there was a risk of going deaf without having the procedure(s). My dad said it was heartbreaking to here me say "What? I can't hear you!" when my ears were clogged.

IANAD but I would seriously consider the risk of permanent hearing damage that could result from her condition. Definitely get a second opinion but this isn't something to be taken lightly. For myself, I would consider the risk of general anesthesia to be much less scary than being deaf.
posted by 6550 at 9:00 PM on December 31, 2005

When I was younger, I had recurring ear infections. Scar tissue made my ear drum a lot thicker than it is supposed to be, which lead to some hearing loss for me many years later. I did, a few years ago, end up getting a tube put in my ear (which I feel actually made my ear worse), but I wish this could've been solved many years ago when it started.
posted by phox at 9:32 PM on December 31, 2005

My understanding is that the risk presented by general anesthesia is fairly minimal. I've been under it (at a young(er) age), and it's not the slightest bit unpleasent, just leaves you kind of drowsy for a while after.

But there is always that chance! I hear you cry...

Everything you do carries some risk, many of which you do without a moments hesitation and for little or no reason, like driving in a car. This has the potential to do a great deal of good for your daughter and I wouldn't let the fear of anesthesia prevent that.

Accoording to this the odds of dying due solely to anesthesia are 1:180000 (via). Your chances of dying in a car crash in a given year are 10 times higher (1:17625, see first link).
posted by phrontist at 9:33 PM on December 31, 2005

I had the same experience as 6550—adenoids taken out, frequent tubes—and my hearing is still shitty, and my nose is frequently stuffed up.

This all happened around when I was five (the adenoids) to ten (the tubes. So many tubes. They look like cute little sewing bobbins two millimeters wide!), so I'd say this:

The tubes helped a lot. My head hurt all the time for awhile, then I'd get some tubes put in, and the crap in my ears would drain onto my pillow, and it'd be a huge relief.

But years later, my hearing still sucks: I have to pop my ears ten times a day when I realize that I'm not hearing any treble.

I would ask a doctor what other options there are, but at age five to ten, I was grateful for the tubes; it usually felt like my head was going to explode, and I could barely hear anything. As for the adenoidectomy, who knows? I certainly don't miss them.

Oh, and what my parents told me to explain the adenoids surgery to me was that it was going to help me sleep better. A pretty good "lie".
posted by interrobang at 9:33 PM on December 31, 2005

I had surgery when I was seven (on my eye). My mother explained the issue very straightforwardly, and I was not scared at all. My only reccommendation is, if you decide to go ahead, do not let them give her flavored gas (they sometimes do for children). Mine was peppermint flavored, and as I puked when I came out, I could not stand peppermint anything for years.

In general, though, surgery is fairly safe. I mean, think of all the adenoidectomies, appendectomies, and tonsilectomies given to children every year. Plus, ear infections suck.
posted by dame at 9:42 PM on December 31, 2005

I had frequent ear infections as a kid, and although I didn't realize it at the time I had trouble hearing. I had my tonsils and adenoids out at six, and tubes put in. All has been well since.
posted by 6:1 at 9:42 PM on December 31, 2005

To me the evidence in favour of surgery seem to be pretty weak, and these problems often get better anyway as the child gets older. The surgery would probably a combination of adenoidectomy and drainage tubes in the ears.

You could try to review some of the benefits and risks yourself at Clinical Evidence. They try to give you the information in a non-biased fashion.
posted by v-tach at 10:03 PM on December 31, 2005

Man oh man oh man ... This stuff is fantastic. Many many thanks to all of you for your input. It never occurred to me that there might be adults out there who remember going through something similar as children - that perspective is priceless. And the links so far look good; I'll definitely read them. Again, happy New Year!
posted by ZakDaddy at 10:48 PM on December 31, 2005

My mother had a similar issue in her childhood. Her parents chose not to treat it (or to not take her to a doctor; I don't really know what happened) and it was the worst decision they could have made. Her untreated hearing problem affected her entire life, even though she did eventually outgrow it. Her issues were likely specific to the time and place she grew up, but you did mention the normal misunderstandings that come with being hearing-impaired--that would be a very real concern on my part.

Do your research, get a second opinion, but if surgery is truly the only option for this, don't let your fear about the surgery override your daughter's health and well-being.
posted by eilatan at 10:51 PM on December 31, 2005

The child has a hearing disability and you are wondering about getting her treament? How distressed must she become before you act in HER interest?
Get a second opinion for sure, but do keep in mind that she is not you and might not have the same level of involvement that you had.
posted by Cranberry at 10:52 PM on December 31, 2005

Side note--I work in surgery. IANAD. Repeated ear infections do wreak havoc on the inner ear. Not to mention all the antiobiotics one has to take to overcome said infections. Get a second opinion and go from there.
posted by 6:1 at 11:07 PM on December 31, 2005

Pediatricians aren't surgeons. There are ENTs that are surgeons.
posted by 6:1 at 11:08 PM on December 31, 2005

Like dame, I had eye surgery when I was 7. My parents were similarly straightforward about what the surgery was for, and why. I wasn't at all afraid going into it, and when I woke up, I got a brand new Batmobile toy to play with. I think I lost all the little rice-grain sized projectiles in the hospital ward.

Don't be afraid to tell your daughter about the surgery, but you don't need to talk about your concern over general anaesthetic. If it makes her life better, do it. I would, if my daughter were (or ever is) in a similar situation.
posted by 5MeoCMP at 11:32 PM on December 31, 2005

I don’t know if you’ve considered this angle: If you do not fix your daughter’s hearing soon, she will miss out on absorbing spoken language from her environment, especially important during her early years. Your average seven-year-old has already learned to speak fairly well, but she’s absorbing vocabulary and new concepts at a phenomenal rate. This is the time when her brain is extraordinarily thirsty for learning, so don’t muffle it. She can’t just make up for it once the problem “clears up” – her brain needs it now.

I would be more concerned about her verbal development than the microscopic chance of problems with general anesthesia – though I can’t tell you if this particular surgery option is the best.

My mom is a respected speech pathologist, and I can ask her advice on these types of speech development issues if you’d like, as I’m home on break. My email is in my profile. Otherwise, there is probably a speech pathologist at your daughter’s elementary school.
posted by Sfving at 1:11 AM on January 1, 2006

IANAD.

There are risks of general anaesthetic but I believe they are much greater for older people, ie 50+. My grandmother has severe dementia thanks to a general when she broke a hip. I had a general when I was about 7 and don't think it had any permanent effects - but really, how could I tell if my mental state would have been different without it? I'm certainly not grossly impaired or anything.

This might be of interest, I googled for '"general anaesthetic" risks age'. It lists a bunch of conditions that have issues with complications; under-5s are the age range listed so you should be fine there.
posted by polyglot at 1:27 AM on January 1, 2006

I had my adenoids out as an infant - I still have my tonsils.

Have you never had general anesthesia? I was beyond scared when I had my first surgery, about not waking up. In fact, my first words upon waking were "Really? It's over?" I know it's scary, but the risk is really, really low.

Problems with hearing can lead to other things, like speech impediments. Have it done.
posted by IndigoRain at 1:31 AM on January 1, 2006

Have you looked at her diet? Ear infections are associated with dairy, among other things. I would try to remove all dairy and see if things improve. See here and here for two articles about it. Dr Fuhrman sounds a bit like a quack, but he gives lots of scientific evidence and his track record is impressive.

If you google "elimination diet" ear infections you'll find lots of information, but be aware of the quacks.
posted by davar at 2:10 AM on January 1, 2006

My sister had her adenoids out around the time she was six or seven years old. No ill affects occurred after the surgery or have occurred since.

Although my sister will get the occasional ear infection.

I am not a doctor and surgeries always involve certain risks, but if this operation will help your child a good idea might be to have the procedure. Though try to get a second opinion from another trusted pediatrician.
posted by Colloquial Collision at 3:04 AM on January 1, 2006

Should you decide to go through with the surgery for your daughter, perhaps your paediatrician or ENT (if you see one) can suggest someone at a/the hospital who can walk you (and perhaps your daughter as well) through the process before it happens.

I'm up for some surgery in February and I'm having someone walk me through the pre- during- and post-operation process - where I'll go, who will be doing what, what anaesthetic I'll be given and how it all feels, etc. Apparently this a service that some hospitals offer for people who are feeling anxious or apprehensive in the lead up to surgery (I'm in Australia, but I can't see why it would be confined to here!).
posted by prettypretty at 4:16 AM on January 1, 2006

I had my adenoids out when I was three. All I remember is the unbelievably nasty smell of gas and then being able to eat all the ice cream I wanted. I haven't had any hearing problems but I'm not sure that's why they took them out.
posted by CunningLinguist at 6:17 AM on January 1, 2006

I had a multitude of ear infections, glue ear, extreme difficulty hearing, and tubes put in my ears when I was 6. (1982).

I remember everyone getting supremely annoyed at me because I didn't hear them unless they yelled/didn't come when called/didn't hear instructions from the teacher in class etc.

No one told me anything about getting tubes in my ears. One morning I got pulled out of bed at 5:30, told not to eat or drink anything, and then we were at the hospital. My parents decided to kill two birds with one stone and have my 3 year old brother get tubes at the same time. I would really suggest letting your kid know in advance that they're going to have a medical procedure.

After the tubes I could hear and the earaches subsided, but we were fanatically and shrilly warned about getting water into them, not putting your head underwater, etc.

To this day I've never learned how to swim because if my head goes underwater, I'll end up in hysterics. I can't let people touch my ears. My boyfriend, the hairstylist, the doctor - no one. I'll start crying. My low end hearing has become really muddy as of late and I'm extremely reluctant to get it checked out and I actually fear mentioning it to my parents.

Get her hearing fixed. Do not make it scary for her. Do not make it seem like her temporary hearing loss is a huge irritant for you.
posted by pieoverdone at 6:27 AM on January 1, 2006

Surgeons tend to see surgery as the best solution because it's what they're expert in. Talk to other experts. And check out the dietary and any other alternative recommendations. Excess secretion suggests allergies. If she has allergies, they'll affect her in many ways; best to investigate now.

I had my tonsils & adenoids out because I got such bad colds and throat infections and it made no difference at all. It wasn't fun but wasn't traumatic. In an unrelated issue, I have had poor hearing from birth. It went undiagnosed for a long time. Your daughter should see a speech therapist promptly for assessment and possible treatment.
posted by theora55 at 7:32 AM on January 1, 2006

I got tubes in my ears after several years of ear infections when I was about 7 or 8. I did not get my tonsils or adenoids out. My response is mostly emotional to your post but it seems like you are looking for first person opinions if I had known my parents knew of a treatment for me to not be in pain for so long and did nothing, I would be furious. As it was, I think they put off the decision for too long, I missed almost two months of school in second grade because of being sick. As it was the trip to the hospital (which I was told about far in advance) was not a huge deal, I was treated well and my ear infections stopped, totally stopped. I didn't miss any more school, I became much less of a paraiah/sickly kid. My grades improved, my interaction with teachers and classmates improved. I did have the water-in-ears flip-out thing that pieoverdone discusses and that was annnoying but not as annoying as being sick or partly deaf all the time. I wore a swim cap with earplugs through a lot of third and fourth grade. The good news is that with the tubes, this worked itself out by the time I was in junior high or old enough to care what people thought of me. The tubes fall out, and your ears go back to "normal."

Now, as an adult person, I am a little hard of hearing because of all the scar tissue that I have over my eardrums from the years of ear infections. My parents were always pretty reluctant to employ a medical solution when a non-medical one would do, and as an adult person I'm a little frustrated by this -- I have one or two ugly scars that might have healed better if my parents had gotten me stitches for example. I respect your concerns about your daughter, and anesthetic, but I personally feel that waiting it out is the wrong decision.
posted by jessamyn at 8:02 AM on January 1, 2006

Our 5 year old just had her tonsils and adenoids out. I was a wreck leading up to surgery, imaging the worst, though I knew how incredibly safe it was. She was in and out in thirty minutes. The week post-op was sometimes tough, but o/w, I'm so glad we did it. Every cold she got either left her in agony with sore throats or she would get an ear infection, or worse, three or four weeks of "what? what?" to every query.

I based my decision mostly on missed school. She gets one chance in life to get an education and this was a set-up for trouble.

I think elimination diets are generally unlikely to help for this sort of thing, but I tell patients if that's what they need to try before something more definitive to go ahead, but don't let a year pass while you do so. If you have eliminated obvious sources of adenoidal inflammation - tobacco smoke anywhere in her life, animals in the house, old HVAC systems, then it pretty much comes down to being the Parent, and making the correct but difficult decision for her well-being.

I might also suggest asking to talk to the ENT, but ask for a specific one, i.e., to the Pediatrician, "Who would you take your child to?"
posted by docpops at 8:20 AM on January 1, 2006

And please don't buy the notion that secretions = allergies. Secretions are normal. Poor drainage is not. Excess secretions are not, but are not allergically mediated, typically. They are caused, if anything, by irritation of the mucous membranes from airborne irritants. That said, if you are looking for an alternative "fix" there are no shortage of gurus out there that will be happy to help who ultimately have nothing at stake in the outcome.
posted by docpops at 8:24 AM on January 1, 2006

Grandkid had tonsils, adenoids, and tubes at about 7 or 8. All things considered, we should have done it earlier. The kid had constant ear infections unless on antibiotics all the time, that's healthy. The kid walked into walls because the adenoids were so big they were blocking the eustachian tubes and it killed the kid's balance. The surgery was no big deal, and the kid was OK with not getting the ears wet for a while, considering the alternative. It was a quality of life issue there at the end. YMMV. Ten years later, the kid can hear fine, and hasn't had an ear infection lately.
posted by deep_cover at 9:42 AM on January 1, 2006

Just as another data point: I had an adenoidectomy when I was a young'un. My hearing is (much?) better than average, but flying, mountains, and elevators are just murder on my face-- pressurization and depressurization are things that I just dread. Also, I'm a below average swimmer thanks in part to spending so much of my youth exclusively on land.
posted by Kwantsar at 10:37 AM on January 1, 2006

I had my adenoids out when I was about 5 or so. I remember throwing up in the recovery room, and being freaked out when one of my tubes came out on the playground a few years later, but I turned out OK.
posted by mkultra at 12:28 PM on January 1, 2006

I also had my adenoids out and had tubes in my ears when I was five. I had no idea it was so common! I turned out fine as well and I don't remember the experience as traumatic in any way.
posted by pazazygeek at 12:57 PM on January 1, 2006

Any ENT worth his salt will recommend what is best for your daughter, not what is best for his pocket book. That said, some surgeons are better than others. Do get a good recommendation for a reputable ENT and a second opinion, just to ease your mind. Voice your concerns; ask any questions you have. And, as others said, consider that not taking action may cause long-term pain and, possibly, permanent damage.

If your ENT recommends surgery: To reiterate, general anesthetic does carry risk, but it is very small in comparison to a lot of everyday things. The surgery itself is simple and quick. Some people do feel nauseated when waking up from surgery.

I would also recommend being completely honest with your daughter (this based on personal experience and second-hand stories). Also, I've been told that "they're going to put you to sleep" is a bad phrase to use because of its connotations to animal euthanasia... it may frighten her.
posted by moira at 1:08 PM on January 1, 2006

I had tubes three times and my adenoids out twice (My ENT said they grow back if any of the tissue is missed the first time around). Waking up from the surgery was a little scary when I was three, but the worst was the nausea and the cold.

I was almost completely deaf until I was six or seven from repeated ear and sinus infections. Also, I have chronic pain from an immune disorder, and nothing has ever been as painful as an ear infection. After my first set of tubes, I was scared of everything that made any sound at all. And I could hear perfectly well before I turned three and started getting the ear infections. I still have speech impediments from losing my intonation when my hearing was at its worst.

To this day my ENT is my hero for fixing my hearing and making the pain go away. Not to mention that I could finally communicate with my classmates.
posted by Elsbet at 9:23 PM on January 1, 2006