Information About Ear Tubes in Children
Placement of ear tubes is one of the most common procedures performed in children in the United States. In most cases, it is a very simple procedure to perform and usually takes less than 10 minutes of surgical time. In young children, the procedure is usually performed at an outpatient surgery center and your child will receive anesthesia gas through a facemask while the tubes are being placed. Usually no iv line is needed at all (if one is needed, it is put in after your child is asleep). For adults, ear tubes can be placed in the office for most patients.
What is an ear tube?
Ear tubes are small devices that create an opening through the ear drum. They are usually made out of plastic or silicon. They are very small (about 3 mm in size) and cannot be seen from outside the ear. Other names you might see for ear tubes include tympanostomy tubes, myringotomy tubes, ventilation tubes, and PE (pressure equalization) tubes.
Picture of a tube in the ear drum
Why do children need ear tubes?
The two most common reasons for needing ear tubes are recurrent ear infections and fluid trapped behind the ear drum (this fluid can also become infected and result in a chronic ear infection). In general, if your child has more than 3 infections in the past 6 months or more than 5 in the past year, I recommend placement of ear tubes. Alternatively, if your child has fluid trapped behind the eardrum which does not go away within 3 months, I recommend that ear tubes be put in. The reason is that fluid behind the ear drum will interfere with hearing and possibly cause speech delay and other problems. There are also other less common reasons that tubes would be needed for children and adults.
Will the tubes prevent future ear infections?
Tubes do not necessarily prevent infections, but they are very helpful in several ways. First, they make ear infections much less painful for your child because the infected fluid can drain out the tube instead of building up pressure inside the ear. Instead of severe ear pain and pressure, infections after tubes usually just cause drainage out of the ear. Another advantage of tubes is that infections can be treated with antibiotic ear drops instead of bad-tasting medicine that has to be swallowed. Some kids will stop getting infections completely and have no drainage at all after tubes are placed. Unfortunately, it is impossible to predict how any individual child will do, but almost everyone does a lot better than before the tubes were placed.
How are the tubes placed?
After your child is asleep, I use a large microscope to look into each ear canal. Any wax blocking the ear canal is cleaned. Then, I make a small incision in the ear drum and suction out any fluid that was trapped behind the drum. Next, I carefully place the ear tube into the opening in the ear drum. Once the tube is securely in place, I put antibiotic drops into the ear and place a cotton ball on the outside.
Are there any special instructions for after the procedure?
Your child will probably be cranky, sleepy, or otherwise not his or her “usual self” for the rest of the day after the procedure because of the anesthesia. Usually, your child will be back to normal by the next day. There are no restrictions on what your child can eat or drink or any activities. It is normal for there to be some drainage from the ears for a few days after tubes are placed. Sometimes there is even some blood in the drainage. This is OK. I will give you a bottle of antibiotic ear drops to use twice daily for 3 days after surgery. There is usually not a lot of pain after the procedure. If your child seems uncomfortable, tylenol is usually helpful for relieving pain. It is common that your child will have a fever after any surgery, especially during the first 24 hours. If this occurs, give tylenol. If the fever worsens or continues to recur more than 2 days after surgery, notify my office.
How long do the tubes stay in the ear?
The tubes usually fall out on their own after about 1 year on average. If they have not fallen out within 2 years of being placed, I will remove them. Removal of tubes also requires a short procedure under anesthesia. Less than 10% of kids with tubes will need to have this done. For a small percentage of children who have required several sets of tubes in the past, I will place longer-lasting tubes, called T-tubes.
Will my child need tubes again in the future?
Research studies have shown that 75% of all children who have ear tubes put in will only need 1 set and then do well after the tubes fall out. The remaining 25% will need at least one more set of tubes.
What are the risks of the procedure?
The procedure is very commonly performed and is very safe. Serious and life threatening problems in healthy kids are extraordinarily rare (as in “getting struck by lightning twice” rare) and are generally caused by bad reactions to anesthesia. The anesthesiologists I work with are excellent and are very experienced with children. There is a risk of a persistent hole in the ear drum after the tube falls out. If this occurs, the hole can be repaired with another operation, usually once your child is 8-10 years old. Persistent holes in the eardrum occur in less than 5% of all cases. There also is a risk of chronic drainage from the ears which does not improve with antibiotic drops. Sometimes this problem requires removal of the tubes. This problem also occurs in less than 5% of cases. Occasionally, the tube will become blocked with wax or dried drainage. If this occurs, antibiotic drops will usually clear the blockage.
Are there any special precautions while the tubes are in my child’s ears?
The main precaution is to try and limit the amount of water that gets in your child’s ears. Lots of water in the ears can get through the tube into the space behind the eardrum. This can sometimes cause persistent infection and drainage. If a small amount of clean water gets in the ears during bath time, it is ok, but if your child likes to swim deep underwater, it is important to get some ear plugs to prevent lots of water going in the ears.
What should I do if there is drainage from the ears?
While your child has tubes in the ears, he will probably have some drainage from time to time, especially if he gets a cold or respiratory illness. The drainage is actually a good thing and is what the tubes are designed to do. Instead of that fluid being trapped behind the ear drum, it can drain out the ears. If drainage occurs, start using antibiotic drops in the ears (5 drops in each draining ear twice a day for 7 days). I will make sure you have a prescription with plenty of refills. Usually this will clear up the drainage within a couple of days. If not, call my office and we will get your child in to be seen.
Please call (512) 550-0321 with any questions! We serve the South Austin Metro Area, including Kyle, San Marcos, and Lockhart.