Ear tube insertion

Answer 1

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.

Answer 2

Definition

Ear tube insertion involves placing tubes through the eardrums. The eardrum is the thin layer of tissue that separates the outer and middle ear.

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

Alternative Names

Myringotomy; Tympanostomy; Ear tube surgery; Pressure equalization tubes; Ventilating tubes

Description

While the child is asleep and pain-free (general anesthesia), a small surgical cut is made in the eardrum. Any fluid that has collected behind the eardrum is removed with suction through this cut.

Then, a small tube is placed through the eardrum. The tube allows air to flow in so that pressure is the same on both sides of the eardrum. Also, trapped fluid can flow out of the middle ear. This prevents hearing loss and reduces the risk of ear infections.

Why the Procedure Is Performed

The buildup of fluid behind your child's eardrum may cause some hearing loss. But most children do not have long-term damage to their hearing or speech, even when the fluid is there for many months. See: Otitis media with effusion

Ear tube insertion may be done when fluid builds up behind your child's eardrum and:

• Does not go away after 3 months and both ears are affected
• Does not go away after 6 months and fluid is only in one ear

Ear infectionsthat do not go away with treatment or that keep coming back are also reasons for placing an ear tube. If an infection does not go away with treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.

Ear tubes are also sometimes used for people of any age who have:

• A severe ear infection that spreads to nearby bones (mastoiditis) or the brain, or that damages nearby nerves
• Pressure injury to the ear from flying or deep sea diving (barotrauma)

Risks

Risks of ear tube insertion include:

• Drainage from the ear
• Hole in the eardrum that does not heal after the tube falls out

These problems do not usually last long. They also do not usually cause problems in children. Your doctor can explain these complications in more detail.

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 doctor may ask for a 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 as the ear tubes are inserted. Your child may be groggy and fussy for an hour or so while waking up 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 doctors will recommend using 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 health care provider.

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 that their children:

• Have fewer ear infections
• Recover more quickly from infections

If the tubes do not fall out on their own in a few years, 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

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.

Casselbrant ML, Mandel EM. Acute otitis media and otitis media with effusion. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 194.

Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. 2010;(10):CD001801.

Reviewed By

Review Date: 04/15/2011

Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

If your child gets a lot of ear infections, he may need to have surgery. Let's talk about ear tube insertion.

So, why does my child need ear tube surgery?

Your child has been having ear infections, probably for a long time, and they either won't go away or they keep coming back. If your child doesn't have ear tube surgery, there's a chance he will lose some hearing or have other long-term ear problems.

Once a decision to have surgery has been made, it's good to know what happens during the surgery. Your child will be given general anesthesia. He'll be unconscious and unable to feel pain. The surgeon will make a small cut in your child's eardrum and remove any fluid behind it. Once the fluid is removed, the surgeon will place a small tube through the eardrum. The tube will allow air to flow inward. This keeps the pressure the same on both sides of the eardrum, while letting any fluid still behind the eardrum flow out.

Your child will probably go home the same day as surgery. He'll probably be fussy and groggy while the anesthesia wears off. On your way home, you may need to stop at the drug store to pick up antibiotic drops to use in your child's ears for the first few days after surgery.

The cut in your child's eardrum will heal on its own, and the tube will eventually fall out. Your child will be able to return to his normal activities shortly. But some doctors may recommend that your child use earplugs when he swims or bathes, to keep water out of his ears.

After a child has ear tube surgery, he will usually have fewer ear infections. And if he does have an ear infection, he will usually recover faster than he used to.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.