Oregon Health & Science University
  • Carol J. MacArthur. M.D.
    As a pediatric head and neck surgeon in the Department of Otolaryngology, Head & Neck Surgery, Dr. MacArthur treats children for all conditions that affect the ear, nose and throat. Her area of specialty is treating vascular birthmarks, such as hemangiomas and other vascular malformations, affecting the head and neck area in children.

Avoid deficits and delays with ear tubes

As a pediatric head and neck surgeon in the Department of Otolaryngology, Head & Neck Surgery, Dr. MacArthur treats children for all conditions that affect the ear, nose and throat. Her area of specialty is treating vascular birthmarks, such as hemangiomas and other vascular malformations, affecting the head and neck area in children.

Ear infections, the most common medical complaint of childhood, can be miserable experiences for both children and parents. We used to recommend that children with recurrent acute otitis media,or RAOM, get tympanostomy tube insertion to reduce the occurrence of infections as a precaution against hearing loss. Following updated guidelines published in 2014 by the American Academy of Otolaryngology–Head and Neck Surgery Society, we now look for signs of existing hearing loss and speech delays with recurrent infections before recommending tube insertion.

Necessary versus discretionary ear tubes for RAOM

The updated guidelines are based on analysis that showed tubes aren’t necessary for all children with RAOM because many had no benefit in speech/language or hearing outcomes with tubes. With this more conservative approach, we recommend tubes when a hearing or speech delay is identified rather than solely on recurrence. For example, if a patient has three ear infections in six months but has a good audiogram, ear tubes may not be necessary.

However, in a shared decision-making model, parents may still choose surgical intervention for several reasons, including a desire to avoid repetitive doses of antibiotics. Also, in children younger than two years old, parents may be unwilling to take the chance that hearing ability or language is affected.

Proactive approach in at-risk children

For children with RAOM or chronic otitis media with effusion who also have special needs, intervention may be more proactive. Influential factors include any cognitive, physical, behavioral or sensory issues that could increase speech, language or learning problems. Examples are children with autism spectrum disorder, Down syndrome or cleft palate, among others. Socio-environmental factors such as impoverished circumstances may also be influential in the decision to move ahead with tympanostomy tube insertion, even without existing speech or hearing issues.

Pediatric services expanding in Washington County

Through a partnership with Tuality Healthcare, OHSU Doernbecher Children’s Hospital will bring specialty expertise and outstanding pediatric care to Washington County this year with outpatient otolaryngology surgeries, a Level 2 NICU and an inpatient pediatric unit at Tuality in Hillsboro.

“Our mission is to be a resource for every child and family that needs us, and these new efforts further that mission to be better stewards of our community,” said Dana A.V. Braner M.D., F.A.A.P., F.C.C.M., physician-in-chief, OHSU Doernbecher Children’s Hospital. “This opportunity allows us to bring the highest quality pediatric services to families in Washington County and the western region to enhance the care of children in a meaningful way.”

Last year, maternal-fetal medicine specialists from OHSU Center for Women’s Health began offering prenatal care for high-risk pregnancies at Tuality Healthcare. Now specialists in pediatric otolaryngology (and soon gastroenterology) are providing outpatient surgeries. Later this year, we will open an eight‑bed pediatric inpatient unit for secondary care and a Level 2 NICU for advanced newborn care. These resources will allow children and parents to stay near their home community while receiving specialized care.

Braner said the expansion should offer primary care providers in the area easier transfers and more rapid acceptances. “To better serve our state and deliver services necessary for kids to be their best we need to be present in communities,” Braner said.

Pediatric team from audiology to anesthesiology

At OHSU Doernbecher Children’s Hospital, every member of our team has pediatric expertise. Our pediatric audiologists have vast experience with young children and special needs children. Our pediatric anesthesiologists are fellowship-trained. Among surgical otolaryngology advances, we have adopted an endoscopic ear surgery approach for most ear surgery beyond ear tube insertion.

When to refer:

  • Children experiencing more than three infections in six months or four in a year, AND associated hearing loss on audiogram, persistent middle ear fluid or speech delay.
  • Otitis media with effusion that is present for more than three months with an abnormal hearing test.

Contact us

OHSU is available to answer questions about tympanostomy tube insertion. Please call the OHSU Physician Advice and Referral Service at 888-346-0644. To refer a patient, please fax to 503‑346‑6854.

Back to articles