Ear Tubes

Ear tubes, also known as myringotomy tubes, are small tubes that are surgically placed into your child's eardrum by an ear, nose, and throat surgeon. The tubes are usually made of plastic or metal. The tubes are placed to help drain fluid out of the middle ear, the space between the ear drum and the inner ear, in order to reduce the frequency and severity of ear infections.

During an ear infection, fluid gathers in the middle ear, which can cause discomfort and affect your child's hearing. Sometimes, even after the infection is gone, some fluid may remain in the ear. The tubes help drain this fluid, and prevent it from building up.

Normally, the middle ears are ventilated by the eustachian tubes, the canals that link the middle ear with the back of the nose. These eustachian tubes help drain fluid and allow air into the middle ear space, equalizing the pressure inside the ear; when they become swollen, the excess middle ear fluid cannot drain out. Ear tubes come in a variety of sizes, shapes, and materials, but they're all designed to allow an alternative way to ventilate the middle ear.

About 1 million children each year have tubes placed in their ears. The most common ages are from 1 to 3 years old, but many older children also undergo the surgery.

The insertion of ear tubes may be recommended by your child's physician and/or an ear, nose, and throat physician if your child has:

• Frequent middle ear infections
• Fluid in the middle ears for more than three or four months
• Fluid in the middle ears contributing to hearing loss or speech delay
• Chronic middle ear infections that do not improve with antibiotics

Once placed, ear tubes are usually successful in significantly reducing ear infections. Most children will get one or two infections a year, and the infected pus typically drains on its own, through the opening created by the tubes.

Myringotomy is the surgical procedure that is performed to insert ear tubes. Ear tube placement is usually an outpatient procedure. This means that your child will have surgery, and then go home that same day. The procedure usually takes about 15 minutes and is done under general anesthesia.

Myringotomy involves making a small opening in the eardrum to drain fluid and relieve pressure from the middle ear. A small tube is then placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The tubes usually fall out on their own after nine to 12 months.

Fortunately, ear tubes require relatively little follow-up. After the surgery, children return to their surgeon's office a month after the procedure, then every six months after that until the ear tubes fall out. By that point, many children outgrow their ear problems and don't require additional sets of tubes.

The risks and benefits will be different for each child. It is important to weigh the pros and cons with your child's physician and surgeon.

Benefits

• Ear tubes help to reduce the risk of future ear infections.
• Hearing is restored in some children who experience hearing problems.
• Speech development is not harmed.
• Ear tubes allow time for your child to mature and for the eustachian tube to work more efficiently. (By the age of 5 years, the eustachian tube becomes wider and longer, thus, allowing for better drainage of fluids from the ears.)
• Children's behavior, sleep, and communication may be improved if ear infections were causing problems.

Risks

• Some children with ear tubes continue to have ear infections.
• There may be problems with the tubes coming out:
• The tubes usually fall out on their own in about one year. After they fall out, if ear infections recur, they may need to be replaced.
• If they 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.
• After they come out, they may leave a small scar in the eardrum. This may cause some hearing loss.
• 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.