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 become a chronic problem leading to other issues such as hearing loss, and behavior or speech problems. In these cases, insertion of an ear tube by an otoneurologist may be beneficial.
What Are Ear Tubes?
Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They may also be referred to as 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 kinds of ear tubes:
- Short term tubes—tubes intended for six months to a year. These tubes are designed to fall out of the ears without professional intervention.
- Long term tubes—as their names describes, these are intended to stay in place for a longer period of time. Their specialized design keeps them in place. They may fall out on their own, but in some cases removal by an ENT is required.
Who Needs Ear Tubes?
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 may 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 eardrum 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, scuba diving, and hyperbaric oxygen therapy.
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 disorders
- Improve behavior and sleep problems caused by chronic ear infections
How Are Ear Tubes Inserted?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. During this procedure, an incision is made in the eardrum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel, but can also be accomplished with a laser. If an ear tube is not inserted, the hole will 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).
Ear Tube 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. Eardrops may be administered after the ear tube is placed and might be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly.
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. Most patients 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, they complain that normal sounds seem too loud. The otoneurologist 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 (eardrum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
- Scarring – Any irritation of the eardrum (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 fewer instances of hearing loss, and are easier to treat – often only with ear drops. Sometimes an oral antibiotic is still needed.
- Ear Tubes May Come Out Too Early Or Stay In Too long – If an ear tube expels from the eardrum 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 otoneurologist.
Consultation with an otoneurologist 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 an anatomic abnormality that inhibits drainage of the middle ear.
If you think that your or someone you love could benefit from ear tube surgery, please call our practice today to schedule an evaluation.