Ventilating Tube Surgery

Middle ear infections (otitis media) are more common in children but may also cause hearing loss in the adult. When repeated ear infections or fluid build-up in the ears do not go away easily or cause hearing problems or speech delays, we may recommend surgery to insert an ear tube to allow the eardrum to equalize the pressure.

ventilating-tube-in-ear2The surgery, called myringotomy with insertion of ventilating tubes, involves a tiny incision in the eardrum and the insertion of small plastic tube through the eardrum to keep the middle ear aerated for a prolonged period of time. Any fluid, usually thickened secretions will be removed prior to tube insertion. Eventually, the tubes will move out of the eardrum (extrude) and fall into the ear canal. Your doctor may remove the tube during a routine office visit or it may simply fall out of the ear.

Less common conditions that may call for the placement of ear tubes are malformation of the ear drum or Eustachian tube, Down’s syndrome, cleft palate, and barotrauma (middle ear injury caused by a reduction of air pressure).

What are risks and complications of ear tubes?
While ear tube surgery is common, minor complications can occur including:

  • Failure to resolve the ear infections.
  • Thickening of the eardrum over time, which affects hearing in a small percentage of patients.
  • Persistent perforation after the tube falls out of the eardrum.
  • Chronic ear drainage.
  • Need for further and more aggressive surgery such as tonsil, adenoid,sinus, or ear surgery.
  • Infection
  • Hearing loss
  • Scarring of the eardrum
  • Possible need to keep the ear dry and to use ear plugs
  • Foreign body reaction to the tube itself – for example, an allergic reaction to the tube material (rare)

What happens before surgery?
In adults, the procedure is performed under local anesthesia in the office. In children, however, the surgery is performed as an outpatient (no overnight stay usually required), at either the hospital or an outpatient surgery center. An anesthesiologist will monitor the child throughout the procedure.

Your child must not eat or drink anything 8 hours prior to their time of surgery; this includes even water or chewing gum. Anything in the stomach increases the chances of an anesthetic complication.

If your child is sick or has a fever the day before surgery, call the office. If your child wakes up sick the day of surgery, still proceed to the surgical facility as planned. Your doctor will decide if it is safe to proceed with surgery. However, if your child has chickenpox, do not bring your child to the office or to the surgical facility.

What to do the day of surgery?
It is important that you know precisely before your surgery date what time you are to check-in with the surgical facility, which is usually two hours before the actual surgery. Bring the required papers and forms with you, including the preoperative orders and history sheets. Your child should wear comfortable loose fitting clothes (pajamas are permissible). Leave all jewelry and valuables at home. They may bring a favorite toy, stuffed animal, or blanket.

Your child may be given a medication to help him or her relax prior to entering the operating room (premedication). In the operating room, the anesthesiologist will usually use a mixture of gas and an intravenous medication for sedation. During the procedure, which typically takes 10 to 15 minutes, your child will be monitored by the anesthesiologist.

After the anesthetic takes effect, the doctor, using an operating microscope, makes a tiny incision in the eardrum through the outer ear canal. There will be no external incisions or stitches. Fluid will be suctioned from the ear, and a tube inserted in the eardrum. Usually, drops will be placed in the ear, and a cotton plug inserted in the ear canal.

What happens after surgery?
An appointment for a follow-up ear check-up should be made 2 weeks after the procedure. At this visit, the position and function of the tubes will be assessed. A hearing evaluation will also be performed to assess hearing function with the tube in place.

Usually, two different types of ear drops will be given to you the day of surgery. Cortisporin ear drops (or its generic equivalent) are to be used immediately after surgery for three days (3-4 drops each ear 3 times per day). If there is drainage from the ear after three days, continue to use the drops until the day before your office visit or as per doctor’s instructions. Discontinue these drops if they cause severe pain or a skin rash develops.

Ear drainage may occur immediately after the procedure or at any time while the tubes are in place. Yellow clear fluid or mucous may drain for several days to weeks after the surgery. It is not unusual to see a bloody discharge following surgery. Cotton can be kept in the ear canal and changed as needed to keep dry. If after the immediate post operative period, profuse, foul-smelling discharge drains from the ear, an infection is the possible cause. If this occurs, call Dr. Dagan.

Conventional medical advice is that water should not be allowed to enter the ear canal while the tubes are in place. Because there is now a passage into the middle ear to allow for ventilation, water can also pass into the middle ear space. If this occurs, ear drainage and infection may follow.  There is an increased risk of infection in lake or pond water, as opposed to chlorinated water found in swimming pools. It is advisable to keep the ears dry in the first two weeks and after that take precautions like swim ear plugs if swimming or bathing. Bathing caps or “ear bandits” are also helpful.

Tympanostomy tubes usually stay in place from 6 to 18 months. If they stay in longer than two to three years, they may need to be manually removed. It is important to have an ear check-up about every six months during this time period. An audiogram is usually obtained at some point after the ear has healed. The tubes eventually fall out of the eardrum on their own as the ear heals. Some children may have mild discomfort or bloody drainage at this time. The small hole in the eardrum at the old tube site usually heals within several weeks.