In a special series called "second opinion," “Today” takes a look at getting a second opinion when surgery is recommended for children. One of the most common surgeries performed on children is for ear tubes tiny tubes that can help prevent ear infections. “Today” host Katie Couric explains how one mother who “shopped” around for the best advice to help treat her child.
Fourteen-month-old Samuel Moutose is a sunny, happy child but his mother, Toni, says that ear infections make him miserable.
“He was up from 2 to 6, really crying, throwing his head back and forth and felt real bad.”
That's why Samuel has had frequent visits with Dr. Joe Elser, a pediatrician at Arkansas Children's Hospital in Little Rock. With multiple ear infections, Samuel might be a candidate for ear tubes which drain abnormal fluid. Fluid in the ears can cause discomfort and promote even more infections.
Elser says to Toni, “How do you think he is doing with his hearing and speech development?”
She replies, “He said momma, some, over the summer and he has said daddy, but he doesn't seem to be making any attempt to say some other words.”
Last summer, it took three rounds of antibiotics to help Samuel over an ear infection -- something his pediatrician is concerned about.
“We are now into very second third line antibiotics to fix his ears. We don't' want him to get into a situation where he is going to have an infection we can't treat. The other thing is that normal speech development by now at a year, he should have 3 to 5 words and in a sense he might not be where he needs to be,” says Elser.
With his treatment options running out, Dr. Elser suggested Samuel see a surgeon for a second opinion.
We asked Dr. Pamela Gallin, author of "How to Survive Your Doctor's Care" and a professor of pediatrics at New York Presbyterian Medical Center, to give Samuel’s mom a crash course on "questions to ask" before getting a second opinion from a surgeon.
“Anytime someone recommends surgery for your family member, you should have a second opinion.”
Gallin recommends checking credentials and making sure the doctor is board certified in his specialty. In addition, it's important to know who is on the surgical team and ask about the anesthesiologist.
“You want somebody who in fact has done an extra year of study in pediatric anesthesia, and if you can't get that, you want an adult anesthesiologist who does a high volume of children”
Most importantly, she says you should ask the doctor for his criteria for surgery.
Dr. Charles Bower, a pediatric ear, nose and throat specialist, or ENT, took a look at Samuel’s ears, and recommended a "wait and see" approach.
Toni asks Bower, “What is your criteria for surgery?”
He replies, “What I would like to see is a minimum of 3 ear infections in six months or 4 in a year before recommending tubes.”
She responds, “He's kind of borderline for needing tubes, and so I was ready to get a second ENT opinion to see what someone else might think.”
Toni decided to take Samuel to another ear nose and throat surgeon. Dr. Michael Key, who sees both children and adults, is affiliated with Arkansas Children's Hospital.
Toni says, “My concerns are any hearing loss that might be going on during these infections and the fact that he is getting these ear infections just in a couple of days of getting a cold.”
Dr. Key says his criteria for surgery in a child is 4 to 6 ear infections during a winter season. “You don't fall into our group that we consider would benefit from having an ear tube put in both ears.”
Toni now says every parent should seek a second opinion before considering their child for surgery. “I definitely encourage a second opinion in the subspecialty area. And I want to encourage other people to do the same especially if it involves your child having surgery.”