Ear tubes

Description
The surgical incision of the eardrum is called a tympanotomy or myringotomy. This minor surgical procedure is most often used for placement of ventilation tubes or tympanostomy tubes (small plastic tubes often called "PE tubes") into one or both eardrums. The tubes ventilate the middle ear space with air and help drain excess fluid from the middle ear. In some cases, tympanostomy or myringotomy will be done without ear tube placement.

Purpose
The eardrum normally vibrates in response to sound waves because the middle ear is filled with air. If the middle ear is filled with fluid, the ability of the eardrum to vibrate changes and hearing is adversely affected. Fluid can collect in the middle ear for various reasons, including the common cold, allergies or a eustachian tube dysfunction. (The eustachian tube connects the middle ear to the back of the nose and throat. When functioning properly, these tubes allow air in and provide a path for fluid drainage out.) If fluid collects and remains in the middle ear, it can provide an ideal environment for bacterial growth.
Ear tubes equalize pressure in the ear by providing ventilation and permitting fluid to drain. It's thought that releasing the excess fluid decreases the chance of ear infections. The release of this fluid also helps restore hearing because the eardrum is once again able to vibrate in response to sound waves.


Causes/associated factors
Various factors may contribute to blocked eustachian tubes and predispose your child to developing chronic ear fluid and infections, including:
recurrent upper respiratory infections
hay fever, or nasal or food allergies
enlarged adenoids (lymph node tissue in the back of the throat that helps filter infections from the body)
allowing a baby to drink a bottle while lying down or propping a bottle in his or her mouth (This practice may cause milk to enter the eustachian tube and accumulate in the middle ear space.)
breathing secondhand smoke
weak immune system
These factors should be addressed before ear tubes are considered.


Indications
According to the Agency for Healthcare Research and Quality, surgery should not be the initial treatment for normally healthy children who have middle ear infections with residual fluid. Ear tubes are recommended only when standard treatment practices (such as antibiotics) fail to clear up chronic middle ear infections or when a middle ear infection with effusion (persistent fluid accumulation in the middle ear space) lasts four months with a proven hearing loss of 20 decibels or more. Ear tubes may also be recommended when both ears are involved or persistent middle ear fluid that interferes with hearing is causing a speech delay.
As with any medical treatment, each case requires an individualized assessment from your child's doctor. Your child may be referred to an ear, nose and throat (ENT) specialist for:

chronic middle ear infections and persistent fluid accumulation
hearing loss
dizziness

Patient preparation
Family education will help you learn more about the procedure, and your child's doctor will give you specific instructions about arranging the surgery. Before signing the surgical consent form, you and your child will have the chance to address any specific concerns.

Procedure
A tympanotomy is often done by an ENT specialist in a same-day surgery center. First, your child will receive general anesthesia. Then, a small opening is made in the eardrum, fluid is suctioned out, and the tympanostomy tube is inserted into the tympanic membrane of the ear. The procedure typically takes about 10 minutes. More time may be needed if other procedures are also done, such as an adenoidectomy (surgical removal of the adenoids).

Postprocedure care
The medical staff will observe your child for one to two hours after surgery, longer if an adenoidectomy was also done. When your child passes the point of postanesthesia nausea or vomiting, he or she is free to eat and drink as usual. After the procedure, your child may need antibiotics or eardrops. As with all medications, follow the doctor's instructions carefully. Acetaminophen may be recommended for any mild discomfort. You will also receive information about follow-up appointments.
For the first few days after the procedure, your child may have ear drainage tinged with blood. If there is significant or new drainage from the tube, however, consult the doctor. Drainage may indicate an infection. Be ready to describe the color and amount of drainage.

Your child won't see or feel the tube(s), but may notice ear popping with cracking sounds when chewing or yawning. The incision(s) usually heal within a few days, and the tube(s) typically fall out on their own within six to 12 months.


Benefits
Ear tubes may decrease the frequency and severity of middle ear infections, which reduces the risk of permanent changes that may develop with prolonged infections. (Studies on the effectiveness of ear tubes provide conflicting information, however. Some demonstrate a short-term decrease in middle ear infections, while others show no difference.) Ear tubes may also improve your child's hearing.

Risks
As with any anesthetic or drug, there's a slight risk of complications related to general anesthesia. Sometimes, the tubes fall out before they provide optimal benefit to the child and need to be replaced. It's also possible for the tubes to remain in the eardrum longer than anticipated. If the tubes are in longer than two years, the ENT will evaluate if the tubes can remain in longer or they need to be removed.
Other risks may include:

tympanosclerosis (hardening of the eardrum)
hearing loss from scar tissue
shrinking of the eardrum, which can also result in hearing loss
eardrum perforation
cholesteatoma (a skin growth in the middle ear)

Considerations
A particular amount of water pressure is needed to push water through the ear tube, so hair washing and bathing are unlikely to cause contamination in the middle ear. Many doctors recommend children with tympanostomy tubes avoid water near their ears or use earplugs, especially with diving and deep-water swimming. Consult your child's doctor for individual instructions.
Remember, there are differing opinions among doctors about this procedure. Be sure to consult your child's doctor with any questions or concerns.