Ear Tubes

What are ear tubes?

Ear tubes are small surgical implants used to treat and prevent certain ear disorders, most commonly recurrent ear infections, chronic serous otitis (“fluid”), or Eustachian tube dysfunction. Ear tubes look like tiny grommets (infact, they are called grommets in many countries). They are placed much like a button into a small slit-like incision in the eardrum, where they heal in place. A typical tube is just over 1mm in diameter. Certain specialized tubes such as T-tubes are larger with a larger flange on the inside of the ear drum. Specialized tubesare used more rarely, mostly in adults who are known to have permanently impaired Eustachian tube function.

What are the indications for ear tube placement?

It is important to remember that no two patients are identical, and there is no hard and fast recipe for when to place ear tubes. In some cases, it is just as reasonable to treat ears nonsurgically for a time in hopes that infections or fluid will resolve as it is to go ahead with surgical tube placement.Generally, there are two main categories of ear disease for which tubes may be recommended:1. Recurrent Middle Ear Infections. A rough guideline would be a recommendation for placementof tubes if there are 4 or more ear infections in 6 months.2. Chronic Middle Ear Fluid (also called Serous Otitis Media). Historically, tube placement was recommended for 3 months of persistent middle ear fluid. More recently, with more knowledge about the effects of fluid on language development, tubes are often recommended after 6-8 weeks of persistent fluid.The decision to place tubes is affected by many other factors, such as: Complications from infections, such as fever-related seizuresFailure of infections to respond to antibioticsComments restricted to single pageAllergic or other untoward reactions to antibioticsHearing loss from fluid or infectionDelay in speech developmentPredisposition to ear infections, such as cleft palate.

Tube placement surgery

In younger teens and children, tubes are placed under general anesthesia in a hospital or surgery center. It takes less than 5 minutes to make a tiny incision, suction fluid from the middle ear, wash the middle ear out with saline, and place the tube to keep the incision open for ventilation.The term “general anesthesia” is used because the child is asleep. In almost all cases, there is no IV placed and the patient breathes without being placed on a ventilator. The medicine used to induce sleep is extremely safeand clears from the body veryrapidly.In adults, the procedure is usually done awake in the office with some topical anesthetic.

Recovery

As a result of the very rapid anesthesia, your child may appear disoriented or very upset for a few minutes after surgery. This is normal. Usually, the child will not even remember this “excitement phase”. There is little to no pain from tube placement, and you oryour child will need tylenol at most. If, however, other surgery such as an adenoidectomy is performed, your child may need a stronger pain medicine.You or your child may eat and drink almost immediately upon waking up, though we recommendstarting withclear liquids.By the day after surgery, you or yourr child should be able to return to normal activities.

Drops

You will be prescribed drops for use after tube placement, or you may get a sample on the day of surgery. How the drops are prescribedvaries from person to person, but we recommend a minimum of 4-5 drops twice a day for at least two days. If there is drainage from the ears, you will need to continue drops until the drainage stops, plus one extra day for good measure.Tips:-Use 4-5 drops.-Massage the drops into the ear to mix the medicinetogether with any infected drainage. -You will not disturb tube placement by using drops.-Do not hesitate to use drops several times a day if a large amount of drainage is noticed.

Ear Drainage

Most people never see ear drainage after tube placement. It is, however, common. Sometimes drainage may occur immediately, but you may see drainage at any time while the tubes are in place or as they extrude (come out). Drainage may be mucous, pus, blood, or any mixture of these. Wax does not count as drainage, and it is normal and healthy.No matter when you may have ear drainage, whetherright after tube placement or a year later, werecommend liberal use of your antibiotic drops. Please make an appointment for about 3 days after drainage starts, so that if it is getting worse instead of clearing, your primary care doctoror ENT specialist can consider prescribing an antibiotic.

Water in the ears

Every child is different, and opinions vary on whether you shouldget water in the ears after tube placement. We recommend water avoidance only if it seems to cause discomfort or infections. Most children tolerate clean water at bath time and in pools, and therefore, it is unnecessary to wear plugs routinely unless your child has one of the problems stated above. Water from lakes, rivers, and oceans is an ecosystem, and you may want to wear ear plugs when swimming in the out of doors.There are custom-sized ear plugs available at our officeif the need arises.

Follow up

It is recommended that a medical provider examine your child’s tubes every 6-12 months. This can be your pediatrician, family doctor, or your ENT. It is not uncommon for a primary care physician to refer you back for a recheckas the tubes come out or just afterwards, particularly if infections or fluid recurs.

Do tubes have to be removed?

Generally, no. The tubes should extrude as the eardrum grows back behind the tube and pushes it out. It then works its way out with the ear wax. Rarely, tubes are removed if they outlive their usefulness or fail to extrude on their own after 2 years.

Complications

The number one complaint about tubes is drainage. Ear drainageoccursin about 1 in 20 children with ear tubes, and it is as common as runny noses. About 3 out of 4 patients never have drainage.About 1-2% of the time, a small hole called a perforation is left in the eardrum after a tube comes out. This may heal on its own or may need to be repaired. We usually recommend observing an ear perforationuntil age 7, then repairing the eardrum. (By age 7, the Eustachian tubes are nearly as mature as an adult’s.)Rarely a small hearing loss is noticed with tubes. This hearing loss is far less than that caused by fluid in the ears and should be temporary, resolving once the eardrum heals. Ear drum scarring is a potential risk of tubes, but it is much less common from tubes as compared with scarring from infectionor from chronic fluid.A cholesteatoma is a collection of dead skin and debris in the middle ear, similar to a sebaceous cyst,that can come from perforations including tubes. This occurs after tubes in about 0.1% of patients