Parents, when told ear tubes may benefit their children, naturally are concerned about a great many things. This document is designed to address the most common concerns of parents. We hope this information will make the experience as understandable and comfortable for you and your child as possible. This information will be presented in "answer form" to the most common questions.
In general, children with three different forms of ear disease can benefit from ear tubes: (1) children with recurrent ear infections, (2) children with persistent fluid in the middle ear, and (3) children with retracted or weak eardrums. We will discuss with you which form or forms of ear disease your child has.
The tubes allow the middle ear to be ventilated. In other words it allows air into the space which normally should have air in it. The reason the fluid accumulates or infection occurs or the eardrum retracts is because the air is not getting into that space. This occurs because the eustachian tube, which ordinarily lets air in, is temporarily not working correctly.
Prior to about 60 years ago, severe ear disease was a rampant problem. The use of ear tubes has also greatly reduced the number of life-threatening ear infections.
Research has shown that children with fluid behind the eardrum will have a hearing loss and might be suffering from needless learning delays. All evidence suggests the delays are rapidly reversible with the return of hearing.
The ear tubes are very effective in treating these problems and, for that reason, are recommended for many children.
In general ear tubes reduce ear infections, improve hearing, and prevent the further degeneration of the eardrum in children with severely retracted eardrums.
Usually your family practitioner or pediatrician is the first to suspect middle ear problems. After an evaluation here, which includes an ear exam by the ear doctor, a tympanogram (a test to determine how much fluid is present) and sometimes an audiogram (a hearing test), a determination as to the need for ear tubes will be made. If surgery is scheduled, you will be given a date convenient for you.
On a day prior to surgery, a physical exam will be conducted and last-minute questions will be addressed.
You will need to bring your child to the hospital very early on the day of surgery. No food or drink can be ingested after midnight the night before surgery. The procedure is usually done between 8 and 10 in the morning. You and your child should be able to leave the hospital an hour or so after surgery.
The anesthesiologist will allow your child to breathe a mixture of oxygen, nitrous oxide (laughing gas), and anesthetics for a few minutes. The ear canals are then cleared of any wax. With the use of a very powerful ear microscope, the eardrum is visualized, a small nick is made in the eardrum, and the fluid suctioned out. A small plastic or metal tube is then placed. The child then gradually wakes up. This process takes about 15 minutes.
Some vague discomfort in the ears is noticed after placing the tubes. This is usually controlled with Tylenol. For 2-3 days after surgery, eardrops will be prescribed. The drops keep blood from clotting in the hole of the tube and prevent infection from setting up around the tube. If pain occurs with the drops, skip a dose or two and resume.
The tubes will stay in place for 9-12 months. They occasionally "fall out" sooner, and often stay in place longer. Sometimes, "T-tubes" are appropriate. These tubes may last for 5-6 years. The reasons for the different tubes will be discussed with you.
About 20% of children will require a second set of "ear tubes." Rarely, a third set of tubes is necessary. In these latter situations, an adenoidectomy is often recommended as well. Occasionally, the tubes may need to be manually removed. In some cases that may require another general anesthetic.
Follow-up with the ear surgeon is recommended every 4-6 months after the tubes have been placed.
General anesthesia carries with it a very slight risk of complication. The anesthesiologist chosen for this procedure is skilled at caring for children and will discuss these risks with you.
Less than 1% of children with ear tubes will have a persistent hole in their eardrum years after the tube falls out. This usually is not a problem and will heal on its own. Rarely, a procedure to close the hole would be necessary.
About 15% of children will have problematic ear drainage after the tubes are placed. Eardrops and, occasionally, oral antibiotics usually control the drainage.
Soapy water or dirty lake water should never be allowed to enter the ear canal. Keeping bath water out with cotton is usually all that is necessary. Soft earplugs are an option and are available at most pharmacies. Custom ear molds can be made and are very effective in keeping water out of the ears. Although a small amount of clean or chlorinated water is usually not a problem, it is suggested as a precautionary measure that a few drops of antibiotic eardrop be placed in the ears if a large amount of water gets into the ear. Some children may experience drainage from the ears after clean or chlorinated water enters the ear. For these children ear molds may be necessary.
In general if the child will be swimming on a regular basis, custom earplugs are recommended.
Certainly more questions will arise, so please feel free to discuss them with us. Most problems can be handled by phone during the day, and we are more than happy to discuss them with you. An ear, nose, and throat specialist is available 24 hours per day, every day of the week for emergencies.
IF YOU HAVE ANY FURTHER QUESTIONS OR DO NOT FEEL THAT THINGS ARE GOING THE WAY THEY SHOULD AFTER THIS PROCEDURE, PLEASE CALL THE OFFICE AT 867-7800.
Content: Joel A. Ernster, MD, FACS