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Ear tube insertion

Definition

Ear tube insertion is the placement of tubes through the eardrums. It is done to help the fluid behind the eardrums to drain so that the ears can function normally, or to reduce the risk of recurrent ear infections.

Note: While this article focuses on ear tube insertion in children, most of the information also could apply to adults with similiar symptoms or problems.

Alternative Names

Myringotomy; Tympanostomy; Ear tube surgery

Description

While the child is under general anesthesia (asleep and not able to feel pain), a small surgical cut is made in the eardrum. Any fluid that has gathered behind the eardrum is suctioned out through this cut. Then, a small tube is inserted through the eardrum. The tube allows air to flow in and fluid to constantly flow out of the middle ear.

Why the Procedure Is Performed

Ear tube insertion may be recommended when fluid builds up behind your child's eardrum and does not go away after 3 months if both ears are affected (or after 6 months if the fluid is only in one ear). Fluid buildup may cause some hearing loss while it is present. But most children do not have long-term damage to their hearing or their ability to speak even when the fluid remains for many months.

An ear infection is another reason for inserting an ear tube. If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

Ear tube insertion is also used sometimes for people of any age who have:

• A complication from a severe ear infection, such as mastoiditis, brain infection, meningitis, or facial nerve paralysis
• Barotrauma (pressure injury) from flying or deep sea diving
• Hyperbaric oxygen therapy

Risks

Risks of ear tube insertion include:

• Scarring of the eardrum
• Drainage from the ear

These complications do not usually last long. They also do not usually cause problems in children. Your doctor can explain these complications in more detail. There is also a very small risk of a hole remaining in the eardrum after the tube comes out.

The risks for any anesthesia are:

• Breathing problems
• Reactions to medicines

The risks for any surgery are:

• Bleeding
• Infection

Before the Procedure

Your child’s ear specialist may ask for a complete medical history and physical exam of your child before the procedure is done. A hearing test is also recommended before the procedure is done.

Always tell your child’s doctor or nurse:

• What drugs your child is taking. Include drugs, herbs, and vitamins you bought without a prescription
• What allergies your child may have to any medicines, latex, tape, or skin cleaner

On the day of the surgery:

• Your child will usually be asked not to drink or eat anything after midnight the night before the surgery.
• Give your child a small sip of water with any drugs your doctor told you to give your child.
• Your child’s doctor or nurse will tell you when to arrive at the hospital.
• The doctor will make sure your child is healthy enough for surgery. This means your child has no signs of illness or infection. If your child is ill, the surgery may be delayed.

After the Procedure

Children usually stay in the recovery room for a short time and leave the hospital the same day the ear tubes are inserted. Your child may be groggy and irritable for an hour or so as they awaken from anesthesia. Your child’s doctor may prescribe ear drops or antibiotics for a few days after the surgery.

Most children can return to normal activities the day after the surgery.

Some ear specialists will recommend earplugs or swimmer’s headbands while swimming or bathing to keep water out of the ears. If earplugs are not recommended for these activities, they may be recommended for diving in deep water. Check with your ear specialist.

The surgical cut heals on its own, without stitches. The hole closes, and the ear tubes usually fall out on their own after 14 months or so.

Outlook (Prognosis)

After this procedure, most parents report their children have fewer ear infections, recover fast from infections, and that they worry less about whether their child has ear infections.

If the tubes do not fall out on their own, an ear specialist may have to remove them. If ear infections return after the tubes fall out, another set of ear tubes can be inserted.

References

American Academy of Family Physicians; American Academy of Otolaryngology - Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004; 113(5):1412-29.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007; 356(3):248-61.

Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 639.