Ear Tubes

1 What are Ear Tubes?

Ear tubes are tiny, hollow cylinders, that are usually made of plastic or metal, that are surgically inserted into the eardrum, they can also be called tympanostomy tubes, ventilation tubes or pressure equalization tubes.

An ear tube creates an airway that ventilates the middle ear and is also responsible for the accumulation of fluids behind the eardrum.

Ear tubes are often recommended for children who have persistent fluid buildup behind the eardrum, especially if it has an effect on hearing and speech development. Your child's doctor may also recommend air tubes if your child gets frequent ear infections.

Most ear tubes fall out within a period of six to nine months, and the holes heal shut on their own. Some tubes need to be removed, and sometimes the holes need to be closed surgically.

2 Reasons for Procedure

In the majority of cases, the reason for an ear tube is to provide long-term drainage and ventilation to the middle ears that have had a persistent buildup of fluid, chronic middle ear infections or frequent infections.

Normal ear ventilation

The Eustachian tubes are usually responsible for the ventilation of the middle ear, these are a pair of narrow tubes that run from each middle ear to high in the back of the throat.

The throat end of the tubes opens and closes to:

  • Regulate air pressure in the middle ear.
  • Refresh air in the ear.
  • Drain normal secretions from the middle ear.

Swelling, inflammation and mucus in the Eustachian tubes from an upper respiratory infection or allergy can block them, leading to the accumulation of fluid in the middle ear. This problem is more common in children, in part, because the Eustachian tubes are narrower and more horizontal, factors that make them more difficult to drain and more likely to get clogged.

Ventilation with ear tubes

Ear tubes provide an alternative airway to keep the air in the middle ear refreshed, allow for normal drainage and equalize the pressure inside the ear.

The tubes are most often used in children with any of the following conditions:

  • Fluid trapped behind the eardrum results in inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur as a result of fluid buildup persistence even after an ear infection has resolved. It may also occur because some dysfunction or noninfectious blockage of the Eustachian tubes.
  • Hearing loss often results from otitis media with effusion. Hearing loss can lead to delays in speech development, communication problems, behavior problems and poor school performance.

Middle ear infections are generally considered frequent if there are three or more distinct episodes in a year. Ear tubes may help prevent recurring infections.

Chronic middle ear infections are long-term infections of the middle ear that do not improve with antibiotic treatment. Chronic suppurative otitis media is a persistent ear infection that often results in tearing or perforation of the eardrum.

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3 Potential Risks

Though ear tube placement can be a very safe procedure, it carries the following risks:

  • Bleeding and infection
  • Persistent drainage of fluid
  • Blocked tubes from blood, mucus or other secretions
  • Scarring or weakening of the eardrum
  • Tubes falling out too early or staying in too long
  • Failure for the eardrum to close after the tube falls out or is removed

Anesthesia

Your child will require general anesthesia before ear tube placement surgery. This process also carries risks.

However, the risks of anesthesia are very low in otherwise healthy children, the following are the possible problems:

  • Allergic reaction
  • Breathing problems
  • Heart irregularities
  • Nausea or vomiting after the procedure

4 Preparing for your Procedure

Instructions on how to prepare your child for an ear tube procedure will be given to you at the hospital.

Information to provide may include:

  • All medications your child takes regularly.
  • Your child's history or family history of adverse reactions to anesthetics.
  • Known allergy or other negative reactions to medications, such as antibiotics.

The following are the questions to ask the doctor or hospital staff:

  • When does my child need to start fasting?
  • What drugs can he or she take before surgery?
  • When should we arrive at the hospital?
  • Where do we need to check in?
  • What is the expected recovery time?
  • How will the anesthetic be administered, with face mask, injection or intravenous (IV) line and who will administer it?

The following tips will help you prepare your child:

  • Start talking about the visit to the hospital a few days prior to the procedure.
  • Explain to your child that the procedure will make his or her ears feel better or make it easier to hear.
  • Explain that a special medicine will help him or her sleep during the surgery.
  • Let your child pick out a favorite comfort toy, such as a blanket or stuffed animal that you can take to the hospital.
  • Explain that you will be present during the procedure.

5 What to Expect

Here’s what you can expect before, during, and after your ear tube procedure.

A surgeon specializing in ear, nose and throat disorders performs the surgery for placing ear tubes.

Anesthesia

The surgeon usually performs the procedure during general anesthesia, so your child isn't aware of anything during the procedure. The anesthetic medication may be inhaled through a mask, injected into a vein or both.

The surgical team places several monitors on your child's body to help make sure that his or her heart rate, blood pressure, and blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on the child's arm and heart-monitor leads attached to your child's chest.

During the tube placement

The procedure usually takes about 15 minutes.

The surgeon:

  • Makes a tiny incision in the eardrum (myringotomy) with a small scalpel or laser.
  • Suction out fluids from the middle ear
  • Inserts the tube in the hole in the eardrum

After ear tube placement

After surgery, your child is moved to a recovery room where the health care team watches for complications from the surgery and anesthesia. If there aren't any complications, your child will be able to go home within a few hours. Your child will likely be sleepy and irritable for the rest of the day and possibly nauseated from the anesthetic.

In most cases, children resume regular activities within 24 hours of the surgery.

Follow-up care

Your child's doctor will advise you about follow-up care after ear tube placement.

Standard follow-up care

If your child has no complications, an initial follow-up appointment will be scheduled within the first two to four weeks after the procedure. At that time, your child's ear, nose, and throat specialist will check for appropriate placement and function of the tubes.

Other follow-up appointments with the otolaryngologist or your child's primary care physician will be scheduled at four- to six-month intervals. Your child's ear, nose and throat specialist may prescribe ear drops to help minimize fluid discharge from the ear. Use the full course as directed by your doctor even if no drainage problems appear.

If the child had hearing loss before the procedure, the doctor will also order a hearing test (audiogram) to assess hearing outcomes after. Your child's doctor may suggest that your child wears earplugs during swimming or bathing.

When To Contact Your Doctor

Reasons to see your child's ear, nose and throat specialist outside of regularly scheduled follow-up appointments include:

  • Yellow, brown or bloody discharge from the ear (otorrhea) that continues for more than a week.
  • Persistent pain
  • Hearing problems
  • Balance problems

6 Procedure Results

Ear tubes are vital in restoring ventilation and drainage of the ear.

Tube placement often results in the following:

  • Reduced risk of any ear infection
  • Restored or improved hearing
  • Improved speech
  • Improved behavior and sleep problems related to frequent or persistent ear infections

Ear tubes cannot fully prevent infections, your child may still have them occasionally. Ear tubes usually stay in the eardrum for six to nine months and then fall out on their own. If a tube does not fall, it will be surgically removed. In some cases, the ear tube falls out too early, and another needs to be put in.

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