MINNEAPOLIS (WCCO) — Ear tubes are the No. 1 reason children get surgery in the United States. Until now, there were no guidelines to help doctors identify who should get the procedure — and who shouldn’t.

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Three-year-old Leah Saacks wasn’t always such a happy kid. A year ago she suffered painful monthly ear infections and medication wasn’t much help.

“The ear infections cause a lot of fluid in her ears and this pressure would wake her up at night and sometimes she was really tired because of that,” said her mother, Dinah Saacks.

Her hearing and speech were also being affected so Leah’s pediatrician recommended inserting ear tubes to keep the ear drum open and prevent fluid buildup and infection. It’s the most common surgery done on children in the U.S.

Now a group of doctors is putting out guidelines for the first time to identify children most likely to benefit from ear tubes.

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“Fluid in both ears for three months or longer in both ears with some hearing difficulties, those are really good kids to get ear tubes,” said Dr. Richard Rosenfeld, of SUNY Downstate Medical Center.

The guidelines say ear tubes surgery should not be performed in children with recurrent ear infections who do not have fluid behind the ear.

Ear tubes are very tiny — only about the size of a grain of rice. Each year more than 600,000 children in the U.S. have surgery for ear tubes.

“It sits in your ear drum for a year or two and it usually falls out on its own,” Rosenfeld said.

For Saacks, it’s changed her daughter’s life. Leah hasn’t had a single ear infection since her surgery last year.

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Children with ear tubes can swim or bathe without earplugs, headbands or other precautions.