Doctor, Please Explain
Ear Tubes
Painful ear infections are a rite of passage for children –
by the age of five, nearly every child has experienced at least
one episode. Most ear infections either resolve on their own
(viral) or are effectively treated by antibiotics (bacterial).
But sometimes, ear infections and/or fluid in the middle ear
may become a chronic problem leading to other issues such as
hearing loss, behavior, and speech problems. In these cases,
insertion of an ear tube by an otolaryngologist (ear, nose,
and throat surgeon) may be considered.
What are ear tubes?
Ear tubes are tiny cylinders placed through the ear drum (tympanic
membrane) to allow air into the middle ear. They also may be
called tympanostomy tubes, myringotomy tubes, ventilation tubes,
or PE (pressure equalization) tubes. These tubes can be made
out of plastic, metal, or Teflon and may have a coating intended
to reduce the possibility of infection. There are two basic
types of ear tubes: short-term and long-term. Short-term tubes
are smaller and typically stay in place for six months to a
year before falling out on their own. Long-term tubes are larger
and have flanges that secure them in place for a longer period
of time. Long term tubes may fall out on their own, but removal
by an otolaryngologist is often necessary.
Who needs ear tubes and why?
Ear tubes are often recommended when a person experiences repeated
middle ear infection (acute otitis media) or has hearing loss
caused by the persistent presence of middle ear fluid (otitis
media with effusion). These conditions most commonly occur in
children, but can also be present in teens and adults and can
lead to speech and balance problems, hearing loss, or changes
in the structure of the ear drum. Other less common conditions
that may warrant the placement of ear tubes are malformation
of the ear drum or Eustachian tube, Down Syndrome, cleft palate,
and barotrauma (injury to the middle ear caused by a reduction
of air pressure), usually seen with altitude changes such as
flying and scuba diving.
Each year, more than half a million ear tube
surgeries are performed on children, making it the most common
childhood surgery performed with anesthesia. The average age
of ear tube insertion is one to three years old. Inserting ear
tubes may:
reduce the risk of
future ear infection,
restore hearing loss caused by middle
ear fluid,
improve speech problems and balance
prob-lems, and
improve behavior and sleep problems
caused by chronic ear infections.
How are ear tubes inserted in the
ear?
Ear tubes are inserted through an outpatient surgical procedure
called a myringotomy. A myringotomy refers to an incision (a
hole) in the ear drum or tympanic membrane. This is most often
done under a surgical microscope with a small scalpel (tiny
knife), but it can also be accomplished with a laser. If an
ear tube is not inserted, the hole would heal and close within
a few days. To prevent this, an ear tube is placed in the hole
to keep it open and allow air to reach the middle ear space
(ventilation).
What happens during surgery?
A light general anesthetic (laughing gas) is administered for
young children. Some older children and adults may be able to
tolerate the procedure without anesthetic. A myringotomy is
performed and the fluid behind the ear drum (in the middle ear
space) is suctioned out. The ear tube is then placed in the
hole. Ear drops may be administered after the ear tube is placed
and may be necessary for a few days. The procedure usually lasts
less than 15 minutes and patients awaken quickly. Sometimes
the otolaryngologist will recommend removal of the adenoid tissue
(lymph tissue located in the upper airway behind the nose) when
ear tubes are placed. This is often considered when a repeat
tube insertion is necessary. Current research indicates that
removing adenoid tissue concurrent with placement of ear tubes
can reduce the risk of recurrent ear infection and the need
for repeat surgery.
What to expect after surgery
After surgery, the patient is monitored in the recovery room
and will usually go home within an hour if no complications
are present. Patients usually experience little or no postoperative
pain but grogginess, irritability, and/or nausea from the anesthesia
can occur temporarily. Hearing loss caused by the presence of
middle ear fluid is immediately resolved by surgery. Sometimes
children can hear so much better that they complain that normal
sounds seem too loud. The otolaryngologist will provide specific
postoperative instructions for each patient including when to
seek immediate attention and follow-up appointments. He or she
may also prescribe antibiotic ear drops for a few days.
To avoid the possibility of bacteria entering
the middle ear through the ventilation tube, physicians may
recommend keeping ears dry by using ear plugs or other water-tight
devices during bathing, swimming, and water activities. However,
recent research suggests that protecting the ear may not be
necessary, except when diving or engaging in water activities
in unclean water such as lakes and rivers. Parents should consult
with the treating physician about ear protection after surgery.
Possible complications
Myringotomy with insertion of ear tubes is an extremely common
and safe procedure with minimal complications. When complications
do occur, they may include:
Perforation – This
can happen when a tube comes out or a long-term tube is removed
and the hole in the tympanic membrane (ear drum) does not close.
The hole can be patched through a minor surgical procedure called
a tympanoplasty or myringoplasty.
Scarring – Any irritation of the
ear drum (recurrent ear infections), including repeated in-sertion
of ear tubes, can cause scarring called tympanosclerosis or
myringosclerosis. In most cases, this causes no problems with
hearing.
Infection – Ear infections can still
occur in the middle ear or around the ear tube. How-ever, these
infections are usually less frequent, result in less hearing
loss, and are easier to treat – often only with ear drops. Sometimes
an oral antibiotic is still needed.
Ear tubes come out too early or stay
in too long – If an ear tube expels from the ear drum too soon
(which is unpredictable), fluid may return and repeat surgery
may be needed. Ear tubes that remain too long may result in
perforation or may require removal by the otolaryngologist.
Consultation with our office may be warranted if you or your
child has experienced repeated or severe ear infections, ear
infections that are not resolved with antibiotics, hearing loss
due to fluid in the middle ear, barotrauma, or have an anatomic
abnormality that inhibits drainage of the middle ear.
Call 972-492-6990 for your appointment today!
972-394-4405 (fax)
