Nicole Marie Galanakis was only 18 months old when she had the surgery. Alex Walters was 3.
Both children had tubes placed in their ears -- a controversial treatment for ear infections that is now believed to have replaced tonsillectomies as the most common surgery performed on children. More than 1 million children get tubes in their ears each year when antibiotics fail to work.
But there is considerable disagreement among pediatricians about when the procedure is necessary. Often, it depends on the length of time a child has had fluid buildup in the ears -- a common condition that can lead to chronic ear infections -- the number of ear infections in any given period, the extent of hearing loss and the child's age.
Last year, a federal advisory panel issued a verdict: Its members recommended that children with persistent fluid buildup in the ears should first be treated with "watchful waiting."
The committee, convened by the Agency for Health Care Policy and Research, said that fluid buildup should not be treated until it has lasted at least three months. The condition, known as otitis media with effusion, often disappears by itself within that time period, they said.
How long to wait before resorting to tubes is an issue facing many parents of young children.
"Eighty percent of children under the age of 4 will have at least one ear infection," says Dr. John Niparko, director of ear surgery at Johns Hopkins Hospital.
Moreover, half of those who have ear infections before the age of 1 will have six or more within two years, says Dr. Kenneth Grundfast, chairman of the department of otolaryngology at Children's National Medical Center in Washington.
"The younger the child, the more frequent the ear infections," says Dr. Jim King a pediatrician at the University of Maryland Medical System.
Ear infections often make young children miserable. They run fevers, have trouble sleeping and eating, and sometimes tug at their ear in pain.
Still, for Becky Galanakis, the prospect of inserting tubes into daughter Nicole's ears was scary.
"I was really, really leery about it at first," she said.
But antibiotics did nothing to stop Nicole's painful, recurring ear infections. So after getting a second opinion, she and her husband, Perry, decided to go ahead with the surgery. Nicole, who is now 6, never suffered from another ear infection.
"It made a world of difference," Mrs. Galanakis said.
The surgery also improved life for Alex Walters, who spent 18 months on antibiotics.
Alex, who is now 5, would get another ear infection every time he went off the medication, said his mother, Susan Walters. He was allergic to two antibiotics and was beginning to suffer a hearing loss from all the infections.
"We really had no choice," said Mrs. Walters, who lives in Baltimore. The tubes didn't eliminate the ear infections, but they did reduce them.
An ear infection occurs when bacteria begin to grow and more fluid is produced as part of the body's response to the infection. Fluid presses against the eardrum, causing pain and sometimes producing a red, bulging eardrum.
Normally, fluid produced in the middle ear drains through the Eustachian tube, a tiny channel that connects the middle ear to the back of the throat. In children, fluid accumulation is common because their Eustachian tubes tend to be shorter, narrower and more horizontal than in adults.
The plastic cylinder inserted into the ear is designed to ventilate the Eustachian tube. "It typically stays in for six to 24 months and [they] fall out on their own, during which the Eustachian tube can develop," Dr. Niparko says.
But it isn't always easy to tell when a child has an ear infection, especially when the eardrum is not inflamed.
"Ear infections, particularly in very young children, can present themselves like other illnesses," Dr. Niparko said.
Physicians in the United States "probably over-treat" for suspected ear infections but do so only "because the complications can be life-threatening and one wants to hedge on the side of caution," says Dr. Maureen Strohm, associate professor of clinical family medicine at the University of Southern California School of Medicine.
These rare complications include a perforated eardrum, mastoiditis (an infection of the mastoid bone behind the ear) or meningitis.
However, when it comes to treatment, the pendulum does seem to be swinging back to the "wait and see" approach, Dr. King says. "Of course, the danger is in the small percentage that can cause serious problems," he says.
In treating ear infections and persistent fluid, the choices usually follow two routes: first, therapy with antibiotics or other drugs, and then -- as a last resort -- surgery, Dr. Strohm says.
Usually, 10 to 14 days of antibiotics will eliminate infections. But the drugs don't always solve the problem.