Myringotomy Tubes (Ear Tubes) Some children require myringotomy tubes (also called ear tubes, tympanostomy tubes, or ventilation tubes) to treat otitis media. What are myringotomy tubes? Myringotomy tubes are small tubes that are surgically placed into your child's eardrum by an otolaryngologist (an ear, nose, and throat surgeon). The tubes are made of plastic, metal, or Teflon. They are placed to help air enter the middle ear in order to reduce the risk of ear infections. During an ear infection, fluid accumulates in the middle ear, which can affect your child's hearing. Even after an infection is gone, fluid may remain in the ear. Myringotomy tubes help prevent fluid from building up. About one million children each year have tubes placed in their ears. The most common ages for placement are from one to three years old. By the age of five years, most children have wider and longer eustachian tubes (a canal that links the middle ear with the throat area), thus allowing better drainage of fluids from the ear. When will my child need myringotomy tubes? Your child may need myringotomy tubes if: otitis media with effusion (fluid) has been present for eight to 12 weeks in spite of adequate medical therapy recurrent episodes of acute otitis media (at least four a year) persistent high negative middle ear pressure associated with one of the following: conductive hearing loss, persistent or recurrent otalgia, persistent or recurrent vertigo, or a retraction pocked of the tympanic membrane complications of otitis media fluid in the ears and more than three months of hearing loss changes in the actual structure of the eardrum from ear infections delay in speaking What are the benefits of myringotomy tubes? The benefits of myringotomy tubes are different for every child. Please discuss these with his/her physician and surgeon. The following are potential benefits: Ear tubes help to reduce the risk in number and frequency of future ear infections. Ear tubes reduce the severity of the symptoms associated with ear infections. Infections are easier to treat. Hearing is restored in some children who experience hearing problems. Speech development is not harmed. Ear tubes allow time for the child to mature and for the eustachian tube to work more efficiently. (By the age of five years, the eustachian tube becomes wider and longer, allowing for better drainage of fluids from the ears.) Children's behavior, sleep, and communication may improve if ear infections were causing problems. For children who have persistent ear fluid, the benefits will be immediate. Once the fluid is suctioned from the ear, hearing is improved. If the fluid is thick, drainage from all the small spaces throughout the middle ear may continue for a day or two. Drainage that the tube provides keeps fluid from coming back as long as the tube is functioning (not clogged with wax or other debris). The tube also allows for ventilation (exchange of oxygen) into the ear. For children with recurrent ear infections, the tube makes it less likely that the ear will become infected in the future, thus reducing the need for antibiotics. However, it is still possible to get an ear infection, especially when the child has a cold. Should this happen, the ventilation tube serves to drain the infected fluid out of the ear. The child will experience less pain and fever than if the infection were undrained (as before surgery). What are the risks of myringotomy tubes? As with all surgical procedures, some risks may be involved with myringotomy tubes. Please discuss the following with your child’s physician and surgeon: Some children with ear tubes continue to develop ear infections. There may be problems with the tubes coming out. They usually fall out after about one year. If ear infections recur, the tubes may need to be replaced. If the tubes remain in the ear too long, the surgeon may need to remove them. About 30 percent of children with tubes have to have tubes reinserted within five years. Some children may develop an infection after the tubes are inserted. Sometimes, after the tube comes out, a small hole may remain in the eardrum. This hole may need to be repaired with surgery. The most common complication of ear tube placement is drainage from the ear. Although the tube is placed to allow for drainage as well as ventilation, sometimes the drainage continues for several days and requires specific treatment. This happens at some point during the life of the tube in about 10 to 15 percent of patients. If drainage continues, the ear may be suctioned to keep the tube from getting clogged and to help in clearing infections. Medicated ear drops are usually prescribed to help fight the infection. Sometimes oral antibiotics may also be needed. How are the myringotomy tubes inserted? The myringotomy procedure is considered same-day surgery. Your child will have surgery under general anesthesia and will go home later that same day. Before the surgery, you will meet with some members of the healthcare team. The team includes: an otolaryngologist: a physician who specializes in the medical and surgical treatment of problems of the ear, nose, and throat an anesthesiologist, who will administer your child’s anesthesia and will monitor him/her during surgery same-day surgery nurses, who will prepare your child for surgery operating room nurses, who will assist your child’s physicians during surgery nurses in the post-anesthesia care unit (formerly called the recovery room), who will care for your child as he/she emerges from general anesthesia Prior to surgery, your child’s anesthesiologist will perform a history and examination of your child and develop a plan of general anesthesia. The anesthesiologist will discuss this plan with you and you may ask him/her any questions you may have. During the surgery, the otolaryngologist makes a small opening in your child’s eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. Your child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to 12 months. Your child's otolaryngologist may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called the nasopharynx) if they are infected. Removal of the adenoids has shown to help some children with otitis media. (link to tonsillitis and adenoiditis) What will happen after myringotomy? Your child will be monitored closely. He/she must meet all discharge criteria in order to go home. What follow-up care is necessary? Your child’s otolaryngologist will determine what follow-up care will be needed. Usually your child will return to see the doctor in about six weeks, then four to six months after the tubes have been inserted, and then approximately one year later. In between these visits, your child’s pediatrician or other primary care doctor will help manage the care of your child in consultation with the otolaryngologist. Generally, the following instructions will be given to you following surgery: Antibiotic ear drops are to be used after the insertion of the tubes to prevent infection. Call your child’s physician if any of the following symptoms occur: drainage from the ear ear pain fever myringotomy tube displaced (out of ear) You will be instructed on the use of earplugs while your child is in the water, based on the opinion of your child's physician. Different physicians may have different recommendations regarding the use of earplugs.
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