Ear infections seem to be as common in children as rain in August. In fact, by the time a child turns five, it is more than likely that they have experienced at least one ear infection. Viral ear infections typically resolve on their own while bacterial infections are treated by antibiotics. Sometimes, ear infections and/or fluid in the middle ear becomes a chronic problem that leads to complications including hearing loss or behavior and speech problems. In cases where complications persist, placement of an ear tube by an otolaryngologist — ear, nose, and throat surgeon — may be considered as a viable solution.

What are ear tubes?

Ear tubes (also called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE — pressure equalization — tubes) are tiny cylinders that are placed into the tympanic membrane — eardrum — to allow air to enter the ear. The ear tubes can be made of plastic, metal, or Teflon and can include a protective coating to reduce the risk of infection. There are two kinds of ear tubes — short-term and long-term. Short- term ear tubes are smaller and typically stay in place for about six months to a year before falling out on their own, as the child develops. Long-term tubes are larger and feature flanges that secure them in place for a longer period of time and may require surgical removal by an otolaryngologist.

Who needs ear tubes and why?

Ear tubes may be recommended when a child suffers from repeat middle ear infections — acute otitis media — or endures hearing loss caused by the persistent fluid in the middle ear — otitis media with effusion. These conditions typically occur in children, but can also manifest in teens and adults. These problems can lead to speech and balance problems, hearing loss, or changes in the structure of the eardrum. Other less common conditions that may warrant the placement of ear tubes include malformation of the eardrum or Eustachian tube, Down Syndrome, cleft palate, or barotrauma — injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes such as flying or scuba diving. Each year, more than half a million ear tube placement procedures are performed on American children, making it the most common childhood surgery performed under anesthesia. The average age of ear tube insertion is between 1 and 3 years old.

Ear tubes help:

  • reduce the risk of ear infection
  • improve behavior and sleep problems caused by chronic ear infections
  • restore hearing loss caused by middle ear fluid buildup
  • correct speech problems
  • decrease balance problems and the presence of vertigo

How are ear tubes inserted in the ear?

Ear tubes are surgically inserted by an otolaryngologist, during an outpatient procedure called a myringotomy. The procedure is generally done under a surgical microscope with a small scalpel, but it can also be accomplished with a laser. If an ear tube is not inserted, the incision that is made would simply heal and close within a few days. To prevent the incision from healing over, an ear tube is placed to keep it open and allow air to reach the middle ear for ventilation.

What happens during surgery?

A light general anesthetic — usually laughing gas — is administered for young children. Some older children and adults may be able to tolerate the procedure without any anesthetic. A myringotomy is performed and the fluid behind the eardrum is suctioned out. The ear tube is then placed into the incision. Ear drops may be administered after the ear tube is placed and may be necessary for a few days after the procedure. The procedure usually lasts less than 15 minutes and patients quickly recover from the anesthesia. Sometimes the otolaryngologist will recommend removal of the adenoid tissue — lymph tissue located in the upper airway behind the nose — during ear tube placement. Evidence-based research suggests that removing the adenoid tissue, in addition to the 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 a recovery room and will usually go home within an hour, as long as there are no complications. Patients usually experience little or no postoperative pain, but sleepiness, irritability, and/or nausea from the anesthesia can sometimes occur. Hearing loss caused by the presence of middle ear fluid is usually immediately resolved by the surgery. Sometimes children can hear so much better that they complain that normal sounds are too loud! The otolaryngologist will provide specific post-operative instructions for each patient that includes when to seek immediate attention and when to schedule follow-up appointments. The surgeon may also prescribe antibiotic ear drops for a few days to prevent infection. To avoid bacteria from entering the middle ear through the ear tube, the surgeon may recommend keeping ears dry by using earplugs or other water-tight devices while bathing, swimming, and other 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 including lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.

Possible surgery complications:

Myringotomy with the insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:

Eardrum perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the 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, including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this does not cause problems with hearing.

Infection – Ear infections can occur in the middle ear or around the ear tube. However, these infections are usually less frequent, don’t result in hearing loss, and are easier to treat – often only requiring antibiotic ear drops. Sometimes an oral antibiotic may be 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 required. Ear tubes that remain too long may result in perforation or may require removal by the otolaryngologist.

When do adults need ear tubes? 

Surgical ear tube placement is much more common in children than adults, but some adults do require ear tube placement as well. Adult ear tubes are placed to correct the same conditions as for kids — chronic fluid in the ear, frequent ear infections, or retracted eardrums. Additionally, it can be prescribed for auditory tube dysfunction, which can be caused by chronic allergies.  

For an assessment for ear tubes for you or your child, contact the ENT specialists at Alpine Ear, Nose and Throat today!

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