Doctor, Please Explain
Ear Tubes
Insight into causes and treatment options
• Who needs ear tubes and why?
• What to expect after surgery
• and more...
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 problems, 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.
Consultation with an otolaryngologist (ear, nose, and throat
surgeon) 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.
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 insertion 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. However, 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.
