October 11, 2016

Ear Tubes

Ear Tubes

Placement of ear tubes (a.k.a. tympanostomy, myringotomy with tube placement, ventilation tubes, and pressure equalization tubes) is one of the most common procedures performed by ENT doctors. In children, it requires a very brief general anesthetic delivered by mask (no intubation, and usually no IV). It is a safe, quick, relatively painless procedure. Using a microscope, a tiny scalpel is used to make a small incision in the eardrum. Any fluid in the middle ear is suctioned out, and a small plastic tube is positioned into the hole in the eardrum.

Most tubes are designed to stay in place for 6-12 months, and the vast majority fall out on their own sometime during this time frame.

When are ear tubes needed?

Usually, ear tubes are recommended for one of the following reasons:

  • Frequent ear infections requiring antibiotics
  • Chronic fluid in the middle ear causing hearing loss or other symptoms
  • Chronic problems with Eustachian tube dysfunction that may lead to permanent structural problems with the eardrum and hearing loss

2013 American Academy of Otolaryngology – Head & Neck Surgery (AAO-HNS) Clinical Practice Guidelines for Tympanostomy Tubes 

These are guidelines from our national academy that give specific recommendations about when tubes are and are not recommended.

  1. If fluid in the ears lasting less than 3 months, tubes are NOT recommended. The reason is most of the time the fluid will go away on its own. When fluid lasts longer than 3 months, the chances of it going away on its own within the next year drop dramatically.
  2. If fluid lasts longer than 3 months, then a hearing test is recommended.
  3. If there is fluid in both ears longer than 3 months and the hearing test shows a hearing loss, then tubes SHOULD be considered.
  4. If there is fluid in one or both ears longer than 3 months and it is causing symptoms (balance problems, poor school performance, behavioral problems, ear discomfort), then tubes SHOULD be considered.
  5. If tubes are not placed, every patient with fluid in their ears should be checked every 3-6 months until: (1) Fluid resolves, (2) Hearing loss is detected, (3) Structural problems with eardrum start to develop. For (2) or (3), tubes would be recommended.
  6. Recurrent ear infections: either 4 infections in the past year (with 1 or more being in the last 6 months), or 3 infections in the past 6 months. If either of these applies, AND there is fluid in the ear(s) when the ENT evaluates the child, then tubes SHOULD be considered. If there are recurring ear infections but there is NO fluid in the ears when the ENT evaluates the child, then tubes SHOULD NOT be placed.

Keep in mind that these are only guidelines, and particular aspects of your child’s case may prompt a different recommendation. For example, we tend to offer ear tubes more liberally in at-risk children, such as those with  preexisting hearing loss, a developmental problem or speech delay, blindness, or cleft lip and palate.

The physicians at Peak ENT will spend the time to counsel you and help determine the most appropriate treatment for your child.