What are tympanostomy tubes?

A tympanostomy tube is a tiny hollow tube that looks like a doughnut and is utilized to treat chronic ear problems. Tubes come in different shapes, sizes and materials. They are inserted into the eardrum and generally extrude spontaneously in 6-18 months.

Why does my child need tympanostomy tubes? How do they work?

Some children develop frequent middle ear infections or retain fluid in their middle ear after an ear infection. This is generally because the eustachian tube, a structure that connects the middle ear to the back of the throat, isn’t working well enough to allow ventilation into the middle ear. Ear infections can be very painful and usually require multiple courses of antibiotics to treat.  By allowing ventilation in the middle ear, the tubes help to decrease the tendency for your child to get ear infections. Fluid in the middle ear can impair hearing and speech development. The tube prevents the accumulation of  the fluid, maintaining normal hearing.

How are the tubes placed?

The procedure is done in the Day Surgery Center under general anesthesia. It takes approximately 10 minutes.  An incision is made in the eardrum. Fluid that is in the middle ear will be removed. The tube will then be inserted into the eardrum. Your child will then be taken to the recovery room to allow him/her to recover from the anesthesia. The doctor will speak to you as soon as the procedure is over.
 
What should we expect after surgery?

Recovery from the procedure is usually very rapid. Your child may complain of some ear pain for a few hours on the day of surgery, which can be treated with Tylenol. There may be some drainage, which may be blood tinged, from one or both ears for several days. This is not worrisome and is treated with eardrops. Your child cannot feel the tubes and cannot reach them with his fingers.
 
Will my child continue to get ear infections after tympanostomy tubes are placed?

Some children with tympanostomy tubes still develop middle ear infections but the severity, duration and frequency is less than that experienced without tubes. These infections usually present with drainage in the ear canal that is crusty or mucous-like and are treated with antibiotic eardrops for 5-7 days. Occasionally, oral antibiotics are needed to treat these infections. If drainage is not present, infection is less likely.

Bloody drainage may sometimes occur. This is not worrisome. It is most likely related to granulation tissue, which is an accumulation of tiny blood vessels around the tube that develop in response to some irritation. This is also treated with eardrops.

How long will my child need the tympanostomy tubes?

The tubes are pushed out naturally by the eardrum. This usually occurs between 6-18 months, but may be earlier or later depending on the tube used. If your child continues to have frequent middle ear infections after the tubes are out, it is possible that the tubes will need to be reinserted.

What does it mean when the tubes come out?

The tube is considered out and non-functioning when it no longer is in the eardrum. The tube may fall out of the ear entirely or it may remain in the ear canal. When this occurs, your doctor may remove the tube from the ear canal during the office visit.

How do I use eardrops?

If drops are prescribed, keep them at room temperature and shake them well prior to use. In order to use the drops, the child should lie with the affected ear upward. The ear should be grasped and pulled upward and outward while instilling the drops. The tragus, a skin flap in front of the opening to the ear, should be pushed in pumping action several times to facilitate entry of the drops into the ear canal. Do not throw the drops away. You may be asked to use them later if your child develops ear drainage.

Should I protect my child’s ears from water?

In the past it was thought that all children with ear tubes needed water protection. The concern was that contaminated water would go through the tube and allow bacteria to settle in the middle ear, causing an infection. More recent data suggests that water exposure is not generally  associated with infection. Some types of water, such as lake or river, seem to be more of a problem. The type of tube used, age of the child, type of water, past history of problems with water and physician preference are all important factors in deciding if your child would benefit from using ear plugs. Specific recommendations will be tailored to the needs of the individual child.

What are the possible complications of tympanostomy tubes?

Rarely, (less than 1%) the incision in the eardrum may not heal after the tube comes out. This perforation may heal spontaneously or may require an operation to repair it. In some cases the tube may not extrude from its position in the eardrum. If this occurs, the tubes will need to be removed surgically and a patch applied to the opening in the eardrum. This is done only if the tube has not come out on its own after 2-3 years and the ear problems have resolved.

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