If you’re a parent, it probably comes as no surprise that middle ear infections are common in children, particularly those between the ages of six months and two years. Known as otitis media, these are caused by a number of factors, both physical and environmental.
Most ear infections clear up on their own, or are treated with antibiotics. But in some children, they can become a chronic problem that causes other issues, such as delays in speech development and learning. For these children, ear tubes may be recommended.
What Are Ear Tubes?
Ear tubes are tiny cylinders, made from plastic or other materials, which are surgically inserted into the eardrum. They are meant to remain in place from six months to as long as several years; at some point they will either fall out on their own, or will need to be surgically removed. They go by a variety of names including tympanostomy tubes, ventilation tubes and PE (pressure equalization) tubes.
The surgery, known as a myringotomy, is an outpatient procedure performed under general anesthesia. Fluid behind the eardrum is suctioned out, a small incision is made in the eardrum, and the tube is inserted. The procedure is quick and painless, and usually takes no longer than 15 minutes.
Myringotomy is a common and safe procedure, and complications are rare. Occasionally, patients will experience a perforation of the eardrum, scarring or infection.
Benefits of Ear Tubes
Ear tubes provide ventilation to the middle ear and allow fluids to drain, reducing the chances of an ear infection from occurring. They can restore hearing loss caused by excess middle ear fluid, alleviate speech and balance problems, and improve behavior and sleep problems caused by ear infections.
Ear tubes are highly effective in reducing chronic ear infections, though some children (approximately 25 percent) who receive them before the age of two may need them again.
Instructions for Patients Undergoing Ear Tubes (Myringotomy with Tubes)
- Some ear pain may be expected for a day or more after surgery from the incision made in the ear drum. This pain should be relieved by Tylenol.
- Drainage from the ear is not more dangerous than drainage from the nose. A little drainage, and possibly even a little blood-tinged drainage, is relatively common during the first few days after myringotomy with tube insertion. However, if the drainage continues for more than 24 hours, fill the prescription for the ear drops and use them for 5 days.
- You have been given a prescription for ear drops, which you do not necessarily have to fill unless the patient experiences drainage. If the patient does experience drainage, fill the prescription and use 3-5 drops to the involved ear three times a day for 4 days.
- If water gets into the ear canal, and then finds its way through the tube into the middle ear behind the ear drum, this can cause pain and infection. However, this is pretty uncommon and usually happens only when the patient is swimming under water, submerged more than 2-3 feet. Therefore, we recommend ear plugs only during active swimming. The ear plugs we recommend are called “Physician’s Choice” silicon “Ear Putty”.
- The type of myringotomy tubes we place usually stay in on an average of 6-12 months. However, sometimes they fall out much sooner than this, especially if they are pushed out by an infection.
- Your first follow-up appointment will be made for you at the time of your discharge from the outpatient surgical center. It will be approximately one week from the date of surgery.
Patient Information for Myringotomy Tubes
Middle-ear ventilating tubes are used to treat eustachian-tube dysfunction and its complications. The eustachian tube is responsible for ventilating and draining the space behind the eardrum into the back of the nose. If the eustachian tube is obstructed, the space behind the ear will not drain, and fluid may collect. If there are bacteria present, it may become infected. Possible causes include bad colds, allergy reactions, enlarged adenoids, chronic sinusitis, and anything else which may cause the tissue in the back of the nose to swell.
The middle-ear ventilating tubes simply bypass the faulty eustachian tube and allow the ear to drain to the outside through the ear canal. Approximately 80% of individuals having ventilating tubes will not require placement of tubes after the first set is gone. Twenty percent of individuals having tubes may require more than one set if trouble develops after the first set falls out. This does not mean the tubes “failed”. The individual has simply remained ear-infection prone, and the tubes are no longer there to help.
Middle-ear ventilating tubes are small plastic or metal tubes, which are designed to artificially ventilate the middle-ear space behind the eardrum. These tubes are inserted through a small, surgically produced hole in the eardrum and are generally left in place until they spontaneously come out. The short operative procedure is usually performed under general anesthesia for infants and children. In most teen-agers and adults, the operation can be done in the office under a mild form of local anesthesia. If there is fluid in the middle ear at the time of surgery, most of it is removed.
The average time for tubes to remain in the eardrum is 6-12 months. Some will come out within 2-3 months, some may stay 2-3 years. After 2 years if tubes are still through the drum, often they are removed to reduce eardrum damage. The tubes generally come out because the eardrum heals behind the tubes and literally pushes the tube out of the eardrum. 98-99% of the time, the eardrum will be totally healed when the tube comes out. In less than 1% of cases, a small hole may remain in the eardrum for an extended period. This hole may require surgical closure at some later date.
The major problems related to placement of middle-ear ventilating tubes include the following:
- With infants and small children, a short general anesthetic is required. There is always some risk of heart, lung, or other serious problems developing with general anesthesia. Serious problems are extremely rare and occur perhaps no more frequently than 1 in 100,000 cases.
- Occasionally, the tube itself may act as a source of infection, or may cause a “foreign-body” reaction, which causes ear drainage and perhaps mild bleeding, but usually no pain and rarely is a serious problem.
- A persistent hole will remain in the eardrum after the tube comes out in less than 1% of patients.
- Rarely, the individual having a tube placed in his eardrum will notice some slight drop in the hearing, rather than an improvement. This is extremely rare and generally only occurs in adults.
Call Eastern Carolina ENT Head & Neck Surgery at 252-752-5227 for more information or to schedule an appointment.
