Ear Infections: What Is a Tympanostomy Tube and What Is It Used For?

Ear infections are a common occurrence in children. Almost all children have got at least one episode of an ear infection by the age of 5 years. Ear infections can be viral or bacterial. Viral infections resolve in their own, while bacterial infections can be effectively treated with antibiotics. However, sometimes, these ear infections can be very troublesome, especially if they become a chronic problem. As a result, many children may develop complications like hearing loss, behavioral problems, speech problems, and poor school performance and attendance. In such cases, an ENT (ear, nose and throat) specialist may recommend the insertion of a tympanostomy tube.

What is a tympanostomy tube?

A tympanostomy tube, also known as an ear tube or grommet, is a tiny cylindrical-shaped tube that is placed through your eardrum to allow air to enter your middle ear. Other names for a tympanostomy tube include myringotomy tubes, ventilation tubes, or pressure equalization (PE) tubes.

Tympanostomy tubes are of two types: short-term and long-term tubes. The short-term tubes stay in the ear for about 6 to 18 months before they fall off on their own, whereas the long-term tubes stay in place for an even longer time and are secured by flanges. These tubes are larger and fall of their own, but may need removal by an ENT specialist.

Who is a candidate for a tympanostomy tube?

Anyone with repeated ear infections or has hearing loss that is caused by a fluid buildup in the middle ear (otitis media with effusion) are the most common candidates for having a tympanostomy tube. These conditions are most common among children, but can also occur in teenagers and adults. Children have a narrow and horizontal eustachian tube that allows germs to enter the middle ear very easily, making ear infections common to them. Other candidates include children with Down syndrome, malformations of the eardrum or the eustachian tube, cleft palate, and middle ear trauma owing to a reduction of air pressure, usually seen in people who engage in scuba diving and flying. Their ear trauma is attributed to altitude changes.

Tympanostomy tube insertion surgery is the most common childhood surgery that is performed under anesthesia.

How is a tympanostomy tube inserted?

This is an outpatient surgical procedure that is done under anesthesia using a surgical microscope. This procedure is known as a myringotomy. Using a small scalpel, a tiny incision is made in the eardrum, and the fluid behind the eardrum is sucked out. The tympanostomy tube is then inserted through this hole. If a tympanostomy tube is not inserted, the incision will heal and close after a few days. The ear tube will ensure the incision remains open and that air will enter the middle ear.

The procedure lasts for about 15 minutes and the patient can go home after staying in the recovery room for an hour or two.

After the procedure, you may feel little or no pain, irritable, and nauseous for a short period of time. Your ENT surgeon will advise you about your post-operative period, when your next visit is, and when you should seek for assistance.

What are the complications?

A myringotomy is a very common and safe procedure. However, rare complications could occur and they include:

• Perforation of the eardrum – This is a very rare complication that occurs when the incision made on the eardrum does not heal. This hole can be easily closed by a surgical procedure called a myringoplasty or tympanoplasty.

• Scarring of the eardrum – Repeated insertion of a tympanostomy tube can lead to scarring known as tympanosclerosis. However, this does not affect your hearing and often does not require any treatment.

• Tympanostomy tubes may fall off too quickly or stay too long – Sometimes, these tubes can fall off very soon, and therefore, will require a repeat surgery to insert it again. If the tympanostomy tube stays for a longer time, it can result in the perforation of the eardrum, and therefore, needs to be removed by an ENT surgeon.

• Ear infections – can still occur even after a myringotomy, but very rare to happen. They usually resolve on their own and will rarely need antibiotics.