Ear tube insertion
Myringotomy; Tympanostomy; Ear tube surgery; Pressure equalization tubes; Ventilating tubes; Otitis - tubes; Ear infection - tubes; Otitis media - tubes
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 similar symptoms or problems.
The tympanic membrane, or eardrum, separates the ear canal from the middle ear.
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.
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 cut in 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.
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 infections that 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
- Injury to the ear after sudden changes in pressure from flying or deep sea diving
Risks
Risks of ear tube insertion include:
- Drainage from the ear
- Hole in the eardrum that does not heal after the tube falls out
- Persistent or permanent hearing loss
Most of the time, these problems do not last long. They also do not often cause problems in children. Your health care provider 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 provider:
- What drugs your child is taking, including 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 may 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 you have been told to give your child.
- Your child's provider will tell you when to arrive at the hospital.
- The provider 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.
When your child's having surgery, it's a big deal to parents. I'm Dr. Alan Greene and I want to talk with you for a moment about how to prepare your child for ear tube surgery. It may seem scary, but ear tube surgery is a lot like just having your ears pierced. It happens to be the ear drum though just out of sight. Perhaps the first thing is preparing yourself because if you're feeling confident and good about the surgery, then everything will go much easier for you and for your child. And that means getting your questions answered beforehand. And in particular, the question I hear the most from parents is concern about the anesthesia. And that comes often from anesthesia risks that happened back when we were children. Anesthesia was much more dangerous than it is today. The problem was there weren't ways to monitor whether kids were getting enough oxygen to the brain or not. But since those monitors were developed about 20 years or so ago now, anesthesia has become incredibly safe - in fact, often safer than driving to the hospital. Now there other things that are important to do to prepare. First is to remember to take notice if your doctor has ordered any lab tests before the surgery. Perhaps blood tests, perhaps urine tests, maybe nothing was needed. But if it was, you want to make sure you've gotten it done before you end up going to the hospital. The second thing are instructions should've been given to you about when is the last time your child could eat or drink before heading to the hospital. Often it'll be midnight the night before, but whatever you were told be sure to take note of that and really don't cheat on this one. Nothing after what they say. And that leads to point number 3. Whatever medications that your child is taking, prescribed medicines, over-the-counter medicines, need to be taken into account. So, make sure you discuss with your physician, your anesthesiologist or the surgeon beforehand whatever medicines your child is taking and whether they should be taken or skipped after that deadline for food and drink. Next thing that's important, number 4, is to help your child select a favorite toy or stuffed animal, action figure to bring with them to the hospital. This little dog here or something that's comforting for them to have with them along the way. And it's a great idea before the whole thing depending on the age and temperament of your child to act out the whole scenario using their favorite toy. So, for instance, this little dog is not feeling well, hasn't been feeling well for awhile, has to take lots of medications, but the doctors are going to be able to fix it. Can't eat or drink anything after midnight - every step of it you go through. They're a little bit scared and they find out everything is fine and it worked out great and they get some ice cream afterwards and the problem is all gone. But to work it through with them so they get the story and it also helps you feel more prepared. I also suggest giving children something specific and fun to look forward to shortly after the surgery. It might be something as simple as a trip to the movies together or a trip to get ice cream but something that they can focus on. Take the focus a little bit off the surgery itself. Not a bad thing for you too. Then a couple of practical things. I do suggest that before going in you take off any jewelry that the child has, you bathe them, you get rid of even earrings that may stay in all the time or hair clips that may, you don't really want those at the hospital. And it's good to choose comfortable clothes when you go to the hospital, things that are easy on, easy off. It's not a fashion show. Although you may want some pictures of this cause it is a kind of historic moment. And lastly, if your child does develop any kind of fever or rash or cold beforehand, make sure to give them a call and let the folks know what's going on cause it may mean the surgery should be postponed. But the good news is that this kind of minor surgery today in children is extraordinarily safe and when it's done for the right child at the right time really helps move them ahead, move the family ahead. Most parents are really glad afterwards that the surgery has been done.
After the Procedure
Children most often 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 provider may prescribe ear drops or antibiotics for a few days after the surgery. Your child's doctor may also ask that you keep the ears dry for a specific period of time.
So your child's had ear tube surgery. What do you need to know when going home? I'm Dr. Alan Greene. I'd like to discuss with you some tips for right after ear tube surgery. First of all, what can you expect after the surgery? Usually because there had been fluid in the ear, hearing will improve right away. In fact, maybe so much so their ears are little sensitive for the first day. There may also be a low grade temperature 99, 100 degrees for a couple of days and it's not unusual at all to have some discharge out of the tubes for 2 or 3 days. The discharge may be clear, bloody, pink, maybe yellow, but some discharge is okay. What kind of care does your child need? Often your doctor will prescribe some pain medications that you want to be sure and give regularly. They work better if given around the clock for the first 2 or 3 days rather than just when the child complains of pain. And your doctor may also prescribe some antibiotic ear drops to help prevent infections. When should you call your doctor back? You'll want to call your doctor if there are signs of an infection developing. Usually you'd see a yellowish, greenish, pussy kind of discharge coming from the ear or a foul smell from the ear. Or your child getting more of a fever or a fever lasting longer than we've discussed. In terms of activity, your child can pretty much do what they feel like. Great activity will not dislodge the tube from the ears. It's not anything you have to be ginger or careful about. But you do want to ask your doctor about whether ear plugs are needed. For some types of ear tubes and some types of activities, they may recommend ear plugs if your child is going to be in the water. For many kids, maybe even most kids, they won't need that. It's also worth knowing that the ear tubes will most likely come out on their own. Usually somewhere between 6 and 12 months or so. And when they do come out, within about 2 weeks the eardrum will spontaneously heal and hopefully just go right on from there. Ear tubes are not expected to eliminate all ear infections, but they hopefully will make your child's ear infections less common and milder and easier to treat when they are present. The first little bit afterwards you do want to avoid harshly blowing the nose because it's a little tender in there, but you don't need to be ginger in any other way than that. Hopefully this will get you through the next few days until you check back in with your physician.
Outlook (Prognosis)
After this procedure, most parents report that their children:
- Have fewer ear infections
- Recover more quickly from infections
- Have better hearing
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.
How do ear tubes fall out and when? I'm Dr. Allen Greene and I want to answer just common questions about that. It turns out ear tubes in general are not intended to be permanent. They're built in a way that as the eardrum grows naturally they'll tend to push the ear tubes out somewhere usually around 9 months. Some are 6 to 12 months. And the reason they're pushed out is the way the eardrum grows and also the tube has a bigger lip on the outside so it pushes them out into the canal rather than in. Nothing you need to do. They're just there and tend to come out on their own. And then within a couple of weeks afterwards the eardrum reseals. There are specific tubes that can be designed to stay in longer - say 2 years or even permanent tubes for kids who have reason to have tubes for the long term. They may need to be then taken out surgically at some point down the road.
References
Hannallah RS, Brown KA, Verghese ST. Otorhinolaryngologic procedures. In: Coté CJ, Lerman J, Anderson BJ, eds. A Practice of Anesthesia for Infants and Children. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 33.
Kerschner JE, Preciado D. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM , eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 658.
Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.
S, Azadarmaki R. Otitis media, myringotomy, tympanostomy tube, and balloon dilation. In: Myers EN, Snyderman CH, eds. Operative Otolaryngology Head and Neck Surgery. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 129.
Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022;166(1_suppl):S1-S55. PMID: 35138954.
Version Info
Last reviewed on: 3/2/2022
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
