Chronic Ear Infections
Ear infections affect up to 75 percent of children in the US by the time they reach the age of three. Children with ear infections may experience earache, fever, ear discharge, and hearing loss. 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, poor school performance, or behavior and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat specialist) may be considered.
Myringotomy and Tubes
What are ear tubes?
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.
Who needs ear tubes and why?
Ear tubes are often recommended when a person experiences repeated middle ear infection (recurrent acute otitis media) or has hearing loss caused by persistent middle ear fluid (chronic otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults. This can lead to speech and balance problems, hearing loss, poor school performance, 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 and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes as in flying and scuba diving).
How are ear tubes inserted in the ears?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to a tiny incision (small opening) in the ear drum or tympanic membrane, which is most often done under a surgical microscope with a small scalpel. 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).
What happens during surgery?
Most young children require general anesthesia. Some adults may be able to tolerate the procedure in the office. 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 opening. Ear drops may be administered after the ear tube is placed and may be prescribed for a few days. The procedure usually lasts less than 15 minutes and patients recover very quickly.
What happens after surgery?
After surgery, the patient is monitored in the recovery room (if general anesthesia was used) and will usually go home within an hour if no complications occur. Patients usually experience little or no postoperative pain, but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily.
Children with speech, language, learning, or balance problems may take several weeks or months to fully improve.
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 rarely 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 surgical procedure called a tympanoplasty or myringoplasty.
- Scarring: Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing and does not need any treatment.
- Infection: Ear infections can still occur with a tube in place and cause ear discharge or drainage. However, these infections are usually infrequent, do not cause hearing loss (because the infection drains out), and may go away on their own or be treated effectively with antibiotic ear drops. Oral antibiotics are rarely 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 an otolaryngologist.
Depending on the type used, the tube remains in place for about 6 months to 18 months or more after the myringotomy procedure. Usually, surgery to remove a tympanostomy tube isn't necessary as the tube often falls out on its own, pushed out as the eardrum heals.