Question for the pediatric docs out there.

My daughter's ear tubes fell out around august/september. One was naturally and the other was a ruptured drum that ended up rupturing twice and requiring IV antibiotics. That ear got cleaned up beginning of october and besides the normal daycare viruses and some strep she has been fine on the ear front for almost 4 months now.

Her procedure is schedule at the beginning of February and my question is should we still do it if she has been ear infection free for 4 months? (despite having plenty of viral infections from daycare)

At this point it is starting to feel more elective than a medical necessity unlike the first set of tubes and I don't see much of a reason to go through with it if we are already making our way through the winter virus slate ok.

The official answer from our Academy guidelines are that you should cancel the procedure.
That being said, I don't think there is a right or a wrong answer here. Her past dictates pretty significant eustachian tube dysfunction, which doesn't normally improve quickly. Her more recent past, however, dictates that you are OK to wait and watch. If you can get some of these kids through the winter months and let them get a little older, frequently they will do fine without a second set. In her case, I might use adenoid size as a significant factor in deciding whether or not I would go ahead with the surgery. If they are moderately to severely enlarged (should have had either an adenoid film done or a nasopharyngoscopy to demonstrate at some point), the likelihood that you will see more ear infections in the near future is really high. And adenoids are mostly growing in the 2-8 years of age range, so she has a way to go before they aren't an issue.
Sorry to be so vague, but there isn't an absolute answer here.

Not a doctor but my kid had tubes at 9 mo and then adenoids out at 15 mo and I was gonna say, go look at the adenoids - which is what Kool said.
For reference, we were doing much better on ears post-tubes but he had been on IV and then oral antibiotics for over 4 weeks (for pinkeye that turned into an infection in the tissue around his eye) and his adenoids were still NASTY.
Post adenoids removal he has had 1 ear infection in 4 years.

Genuinely curious why we don't remove tonsils and adenoids in all kids these days. What purpose do they serve that is bigger than the risk they end up with ones on the larger side that end up causing sleep problems later in life. Having them removed at 50 SUCKS! My son had two sets of tubes before he was four and they removed them the second time. My daughter had no ear issues at all but had them removed at 9 due to sleep issues. They're adults now and I'm not aware of anything related to not having them.

Genuine question for the docs on here.

There is no good reason to remove tonsils and adenoids in every child, which was almost the routine in some places decades ago. They are a part of your immune system, making antibodies aimed at upper airway bacteria and viruses.

With regards to adenoids, if they are significantly enlarged, they can block and re-infect the Eustachian tube, so removing them makes good sense if they are enlarged and/or if a second set of ear tubes needs to be done. The tonsils and adenoids together can get too enlarged and cause airway obstruction, which definitely needs to be addressed. There is always a risk of general anaesthesia regardless of the length of the surgery, and there have certainly been postoperative deaths from bleeding from tonsillectomy (much less so with adenoids). It's the same principle as not taking out everyone's appendix, gallbladder, wisdom teeth, etc., unless the issues they are causing outweigh the risks of the surgery.

They didn't check the size of the adenoids they just said data indicates it's better to go ahead and do the adenoids at her age if you are going to replace the tubes so you don't eventually end up with a 3rd set of tubes.

If she's been 4 mo free, I would probably make them check them before putting her under again. It's a simple quick noninvasive check in office at ENT.

I would wait and see if it was my kid/patient. Also see if she will use an Otovent to pop open those eustachian tubes.

Amazon.com: Otovent Glue Ear Treatment by Otovent with 10 Balloons : Baby

I just saw a device that I had never seen before but it may be more effective than Otovent, just more expensive and it doesn't state what age it is safe for.

Amazon.com: Ear Pressure Relief Device, Ear Pressure Relief for Flying, Diving, 3 Replacement Heads,Ear Care, Eustachian Tube Unclogged-004 : Health & Household