Ear Tube Placement

Infection of the middle ear or Otitis Media is very common in young children. This refers to an infection in the area behind the tympanic membrane or ear drum within the ear. The infection usually occurs along with or following a cold and may resolve on its own (viral) or may require a course of antibiotics (bacterial). Occasionally, the infection may not resolve completely with the formation of pus or clear fluid in the middle ear. This may cause difficulty in hearing and problems with balance. School going children may face complaints of inattention due to their poor hearing.

To remedy these problems and to provide for release of the accumulated fluid, your otorhinolaryngologist or Ear, Nose and Throat surgeon (ENT) may recommend placing ear tubes in the tympanic membrane. Alternate names for ear tubes are tympanostomy tubes, ventilation tubes (also called grommets), myringotomy tubes (myringo- referring to the eardrum) or pressure equaliser tubes. These are left in place for optimal drainage of the fluid.

Indications for Ear Tube Placement

• Acute Otitis Media: This is an infection of the middle ear that develops quickly and generally lasts for less than 3 weeks.
• Otitis Media with Effusion or ‘Glue Ear’: This is a condition in which the middle ear cavity gets filled with a substance that resembles glue. It may occur following infection and is thought to result from a blocked eustacian tube (a tube that connects the middle ear and throat which equalizes pressure).
• Recurrent Otitis Media: Children experiencing three or more episodes in 6 months or four or more episodes annually should be evaluated for benefit from an ear tube to prevent recurrence.
• Chronic Middle Ear Infections: These are conditions with prolonged ear infection and fluid build-up
• Chronic Suppurative Otitis Media: This is a severe ear infection which slowly damages the middle ear and also ruptures the eardrum.
• Barotrauma: This is the potential for damage to the ear from large pressure differences such as experienced during deep-sea diving and flying at high altitudes. Ear tube placement may help in rapid equalization of pressures.

Ear Tube Placement Procedure

The ear tubes are inserted through a surgery called myringotomy. This refers to the process of cutting the tympanic membrane by a small amount which allows insertion of the ear tube. This is generally a day-care procedure and lasts only about 20. Young children would often require general anesthesia to help them cooperate with the procedure.

Before the Procedure

The surgeon who would be performing the surgery would review the history, physical exam and laboratory tests and refer for visit to the anesthesiologist for evaluation. This evaluation would include a history of any previous surgeries and their outcomes, any medications, allergies and other medical conditions, followed by a general physical exam.

Once declared fit for the procedure, the date and time would be fixed. On the day of the procedure, the team would once again review the details of the procedure and proceed to place the individual under general anesthesia.

During the Procedure

This is a very short procedure. The surgeon visualises the ear drum with special magnifying lenses through a probe placed in the ear canal. A small nick or incision is made into the ear canal using a scalpel. The fluid within the middle ear cavity is drained using a suction probe. The ear tube is then placed within the hole in the ear drum.

Occasionally, the surgeon may recommend removal of the adenoids (lymphatic tissue in the back of the throat which can block the eustacian tubes). They may undertake this procedure at the same time and this has benefits in reducing the risk of recurrent infections.

After the Procedure

Recovery from the procedure is rapid. The individual is usually monitored for up to 2 to 3 hours to ensure no complications. The child can be taken home on the same day.

Hearing improves almost instantly in those with fluid build-up and a dramatic change in behavior at home and school may be noted although it would take a few more months for improvements in speech and language.

Your doctor may prescribe antibiotic ear drops for a few days to prevent infection. There is currently no recommendation for protection of the ears from water. However, do follow the recommendation of your doctor with regard to activities such as swimming and deep sea diving.

Complications of Ear Tube Placement

It is very rare to encounter complications after myringotomy, but these are a few possible ones to look out for.

• Infection in the ear: These usually resolve on its own or may require antibiotic ear drops.
• Blockage of the tube: A re-examination should be done with the consideration of a second surgery to replace or remove the ear tube.
• Scarring with the resultant weakening of tympanic membrane called tympanosclerosis. This generally doesn’t affect hearing and requires no treatment.
• Perforation of the Tympanic Membrane: This can occur when the tube falls out or is removed with the persistence of the hole. This may heal on its own or can be mended through a procedure called tympanoplasty.
• Early falling out of the ear tubes with build up of fluid. This may require a second surgery.
• Extended duration of ear tube placement can lead to scarring and perforation and should thus be removed.

References:

1. Ear tubes. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/ear-tubes. Accessed Aug 22, 2018
2. Ear infections in children. National Institute on Deafness and Other Communication Disorders. Accessed Aug 22, 2018