Ear tubes

Overview

Ear tubes are tiny, hollow cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum. An ear tube creates an airway that ventilates the middle ear and prevents the accumulation of fluids behind the eardrum. Ear tubes can also be called tympanostomy tubes, ventilation tubes, myringotomy tubes or pressure equalization tubes.

Ear tubes are often recommended for children who have persistent fluid buildup behind the eardrum, especially if the condition causes hearing loss and affects speech development. Your child's doctor may also recommend ear tubes if your child gets frequent ear infections.

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

Why it's done

An ear tube is used most often to provide long-term drainage and ventilation to middle ears that have had persistent fluid buildup, chronic middle ear infections or frequent infections.

Normal ear ventilation

Ventilation of the middle ear is normally accomplished by the eustachian tubes — narrow tubes that run from each middle ear to high in the back of the throat. The throat end of each tube opens and closes to:

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

Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection or allergy can block the tubes, causing the accumulation of fluids in the middle ear. This problem is more common in children, in part because their 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 drainage and equalize the pressure inside the ear with air pressure outside the body. The tubes are most often used in children with one of the following conditions:

• Fluid trapped behind the eardrum results in inflammation and fluid buildup (effusion) in the middle ear with or without bacterial or viral infection. This may occur because the fluid buildup persists even after an ear infection has resolved. It may also occur because of some dysfunction or noninfectious blockage of the eustachian tubes.
• Hearing loss often results from otitis media with effusion, which is middle ear infection in trapped fluid. 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 six months or four or more episodes in a year. Ear tubes may help prevent recurring infections.
• Chronic middle ear infections are long-term infections of the middle ear that don't improve with antibiotic treatment.
• Chronic suppurative otitis media is a persistent ear infection that may result in tearing or perforation of the eardrum.

Risks

Ear tube placement is a relatively safe procedure with a low risk of serious complications. Possible risks include:

• 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 of the eardrum to close after the tube falls out or is removed

Anesthesia

Surgery for ear tube placement usually requires general anesthesia, which carries some risks as well. Although the risks of anesthesia are very low in otherwise healthy children, possible problems include:

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

How you prepare

You'll receive instructions from the hospital on how to prepare your child for surgery to place ear tubes.

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

Questions to ask your doctor or the 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 a face mask, injection or intravenous (IV) line — and who will administer it?

Tips for helping your child prepare include the following:

• Start talking about the hospital visit a few days before the procedure.
• Explain that the procedure will help 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 there during the procedure.

What you can expect

Before the 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 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 your child's arm and heart-monitor leads attached to your child's chest.

During the procedure

The procedure usually takes about 15 minutes. The surgeon:

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

After the procedure

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.

Hearing loss caused by fluid in the middle ear is immediately resolved by 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 (otolaryngologist) 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 eardrops 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 afterward.
• Your child will likely not need to wear earplugs while swimming or bathing unless his or her doctor suggests them.

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 or balance problems

Results

Ear tubes help restore ventilation and drainage of the ear. Ear tube placement often results in:

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

Even with ear tubes, your child may still get an occasional ear infection.

Usually, ear tubes stay in the eardrum for six to nine months and then fall out on their own. Sometimes, a tube doesn't fall out and needs to be surgically removed. In some cases, the ear tube falls out too soon, and another needs to be put in.