Are grommets over prescribed in children?; Kangaroo care and infant mortality; long term survival following a heart attack; should biological sex be considered in cancer care?

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Are grommets being over‑prescribed for children with recurrent ear infections?

Tegan Taylor 0:02

This is an ABC podcast.

Norman Swan 0:06

Hello and welcome to this week's health report with me, Norman Swan.

Tegan Taylor 0:09

And me, Tegan Taylor.

Norman Swan 0:13

Today, the long-term survival rates of people after a heart attack, who does well and who doesn't.

Tegan Taylor 0:18

The difference that biological sex makes in how cancer is treated, skin-to-skin contact or medical intervention for extremely small premature babies.

Norman Swan 0:26

Why not have both? And a condition that's kept many parents awake at night, comforting a crying, feverish child who turns out to have a middle ear infection, otitis media. And some parents have to deal with this again and again and become worried about the amount of antibiotics their child is having. Sometimes the GP refers the child to an ear nose and throat surgeon in the hope that maybe inserting tubes, grommets through the eardrum might help. The operation is called tympanostomy with tube insertion. Now a trial has been done comparing repeated courses of antibiotics with grommets study leader was Professor Alejandro Hoberman, Chief of General Academic Pediatrics at the University of Pittsburgh Medical Center Children's Hospital, and I spoke to him earlier.

Norman Swan 1:08

Uh welcome to the Health Report. Thank you. What did we know before you did this study?

Alejandro Hoberman 1:13

Well, we knew that uh children uh have frequently recurring acuteotitis media. Uh acute media infections is the most common reason for children to get an antibiotics. And we do know that about twenty percent of children experience recurrent acutitis media and that previous studies that had been done, usually in the eighties and nineties, except one that was conducted in two thousand and twelve, were done before the introduction of pneumococcal conjugate vaccine as a routine immunization for children. And the main goal of placing tin panostomy tubes in children has been to reduce the rate of ear infections after placement of tympanostomy tubes or grommets. And following that, the concern was that if we use an microbial treatment with episodes of ear infections, we will enhance the likelihood of children harboring a resistant pathogen that then is gonna cause the next ear infection.

Alejandro Hoberman 2:06

So those were the two main reasons for placing Timpanostomy tubes.

Norman Swan 2:09

So the conversation about glue ear has disappeared. I mean in the olden days, you know, you had this gunk inside the middle ear and you could see the fluid there. It was affecting the child's hearing. And that was one reason why, particularly in um and and sometimes in uh disadvantaged kids, particularly Aboriginal kids in Australia, you would have a perforation and a discharge from the ear as well. So there was this whole debate about glue ear as well and loss.

Alejandro Hoberman 2:35

Sure. So the uh you know, specific populations may be at higher risk and and I'm those are not the patients that we enrolled in our clinical trials. I would say the ship of the glue ear and the artitis media with the fusion sailed many years ago. And my mentor Jack Paradise, and I my endowed my endowment at Children's Hospital is is the label the Jack L. Paradise Endowed Professor of Pediatric Research. Is uh he conducted a study in the late nineties and uh during the early two thousands in which he showed that among children with persistent fluid in the ear or glue ear. those children did not benefit from tympanostomy two placement for varying periods of time, longer periods of time. And there was not much benefit, and there was no impact on the child's language acquisition and um on their cognitive skills because they were tested all the way through like when they were like 10 or 11 years old, and they were not smarter because of getting grommets placed.

Alejandro Hoberman 3:34

So that that's not the population we studied in this study. In this study, we were dealing with so what happened over the years, we stopped doing grommets for persistent middle-year effusion and We continue doing a lot of grommets for recurrent acutotitis media, recurrent bouts of your infection. With the thinking was that if you put grommets in, you would decrease the frequency of episodes and then you will not expose them to multiple course of antibiotics, hence making them more likely to have resistant bacteria with the next infection.