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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.
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?
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 prob-lems,
and
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. 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).
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. 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.
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 in-sertion
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. How-ever,
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.
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.
Did you know that
ear tubes often get plugged with wax
or fall out prematurely
setting you child up for another painful ear
infection. Monitor your child's ear tubes from
home and detect problems early!
Now there is an
inexpensive and easy way to check
your child's ear tubes at home.
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