TUBES AND TONSILS: SURGERIES HAVE BECOME A PART OF GROWING UP

Mention tubes and tonsillectomy to Sabrina Newman of Sikeston and her smiling face reflects a mother's relief.

Newman's young sons had suffered from repeated ear infections. They were constantly in and out of doctors' offices, and on various antibiotics. The infections continued to reappear like a bad dream.

But tubes for Blake Newman, 15 months, and Zachary Newman, 6, as well as the removal of Zachary's tonsils and adenoids have put an end to the recurring infections.

"It's made a big difference," she said.

"From the time he (Zachary) was 2-months-old we were at the doctor's monthly, if not more, with ear infections and a soar throat."

Zachary was 2 years old when he had his first set of tubes. The tubes stayed in for about a year. After the tubes fell out, Zachary suffered recurring infections.

In December 1992, Cape Girardeau physician Richard Martin -- an ear, nose and throat doctor -- put in a new set of tubes and removed Zachary's tonsils and adenoids.

Ear infections were also a regular problem for Blake, beginning when he was about 2 months old, said Newman.

"The longest we would go without antibiotics would be a week," she said. "We sat up many nights with ear infections."

Earlier this month, Martin put tubes in Blake's ears.

The tubes have made a dramatic difference. "His ears haven't been hurting," said Newman. "He used to have a chronic runny nose."

Since the insertion of the tubes, Blake no longer has a runny nose, she said. "I'm all for tubes and (removal of) tonsils."

Blake and Zachary are not unique in having tubes. The surgery ranks as the second most frequently performed operation on American children, ranking only behind circumcision.

The tubes are tiny plastic or metal tubes, barely bigger than a pinhead, shaped like a bobbin or a T.

The procedure, called tympanostomy surgery, involves making a slit in the eardrum and suctioning out the backed-up fluid in the ear. A tube is then inserted in the eardrum to prevent the incision from closing.

By allowing air to pass through the eardrum, the tube equalizes pressure on both sides of the membrane and permits fluid to drain more efficiently from the middle ear, reducing the likelihood of ear infections.

"As the tube sits there, the eardrum constantly tries to push the tube out," explained Martin.

The bobbin-shaped tube, which is smaller than the T-shaped tube, will usually remain in the ear for about seven or eight months on average, while the T tube will stay in for about two years, Martin said.

The tubes are designed to fall out on their own, after which the eardrum reseals.

Statistically, two-thirds of patients are "cured with just one set of tubes," he said.

Martin said his youngest tube patient was an 8-month-old child with meningitis.

Middle-ear infections, if they go untreated, can cause serious problems. They are the number one cause of meningitis, he said.

Ear infections generally are more of a problem for younger children, from birth to age 5. Such children often have allergies, which aggravate the situation, he said.

Children who have repeated ear infections -- at least three serious infections within one year -- are strong candidates for tubes, Martin said.

Doctors often remove tonsils and adenoids from children who suffer recurring infections.

Last year, about 1,300 surgical procedures involving insertion of ear tubes, and/or removal of tonsils and adenoids occurred at Cape Girardeau's two hospitals and Doctors Park Surgery Inc. combined.

At St. Francis Medical Center last year, 163 tympanostomy surgeries, 189 adenoidectomies and 190 tonsillectomies were performed.

At Southeast Missouri Hospital, 178 tympanostomies, 274 combined tonsillectomies and adenoidectomies, 43 adenoidectomies and 37 tonsillectomies were performed in 1993.

About 300 such procedures were performed at Doctors Park outpatient surgery last year, with tubes accounting for 190 of them.

Between 1978 and 1986 alone, Martin said, he performed about 1,200 outpatient adenoidectomies and tympanostomy surgeries.

Adenoids and tonsils can be chronically infected and become enlarged, said Martin.

Tonsillectomies are generally not done on children younger than 1 year of age, he said.

Tonsils, the almond-shaped lymphoid tissues located in the back of the throat, serve as interceptors of bacteria entering the throat. As the body fights bacterial disease, the tonsils may become infected.

Adenoids are a mass of lymphoid tissues located in the throat, behind the nasal passages. Enlarged adenoids can interfere with breathing through the nose and also block the eustachian tube which connects the back of the throat and the middle ear.

Thirty-five years ago, tonsils were routinely removed in what was a predictable rite of passage for youngsters.

During the 1930s and 1940s, few children reached their teens with their tonsils intact. As many as 1.5 to 2 million tonsillectomies were performed during the 1940s.

Today, about 600,000 to 750,000 tonsillectomies are performed in the United States. Still less is the incidence of twins undergoing tonsillectomies. This occurs in about one of every 100 such surgeries.

Over his 20 years in practice, Martin has seen 13 sets of twins who required tonsillectomy. Recently, he performed tonsillectomies on two sets of twins on the same day in the same hospital.

The primary reason a youngster undergoes a tonsillectomy is because of chronic sore throat or strep throat, Martin said.

"Today, physicians rarely rush to remove tonsils," he pointed out. "Tonsils are particularly important in the early years of life.

"Both tonsils and adenoids are filled with literally millions of lymphocytes that help to fight infection and monitor the bacteria that grows in the crypts of the tonsils and adenoids. They help to build immunity to the system against the common bacteria and viruses of childhood," said Martin.

Tonsils, he said, may have some limited function beyond the age of 5 or 6, but as a child approaches 6 years of age, the sinuses take over as a filtration mechanism and the tonsils begin to play a lesser and lesser role.

"Having a tonsillectomy certainly is no longer "just a part of childhood," said Martin. "But for some patients, it can make a difference in their overall health -- and that's the kind of difference physicians want to make."