Myringotomy with Tympanostomy Tubes

General Background:

Since 1952, tympanostomy tubes (PE tubes or ventilation tubes) have been used as a form of treatment for recurrent ear infections, abnormal pressure and fluid behind the eardrum due to abnormal middle ear ventilation. Over two million of these operations are performed yearly in the United States, yet some controversy exists regarding the risks and benefits of the procedure. The underlying cause for abnormal ear ventilation is eustachian tube dysfunction (ETD). The eustachian tube connects the back of the nose to the middle ear, and is responsible for middle ear pressure equalization. The popping sensation felt in the ears when climbing or descending from altitude is air pressure being equalized through the eustachian tube. Eustachian tube anatomy in children predisposes them to some degree of ETD. Other factors that contribute to ETD include history of cleft palate, chronic sinus disease, chronic seasonal allergies, and acid reflux disease.

Tympanostomy tubes not only reduce the number of recurrent ear infections but also immediately eliminate the hearing loss that results from fluid or pressure changes behind the eardrum. It is now known that this hearing loss, if not treated, will result in psychological, social, and educational problems, especially in young children and it is also known that the tympanostomy tubes are the only reliable method of eliminating this hearing loss. The tubes usually stay in place 4-12 months at which time they are "pushed out" of the eardrum. If, during these 4-12 months, the ear and its ventilation system have returned to normal, a child will need no further therapy. On the other hand, if the ear and ventilation system have not returned to normal, as occurs in about 1 out of 3 children, the tubes must be replaced.

The Procedure:

The surgery to for tympanostomy tube is done in an ambulatory setting under general anesthesia for children and local anesthesia with IV sedation for adults administered by our MD Anesthesiologist and typically takes less than twenty minutes. A small hole is made in the eardrum with a knife and any middle ear fluid is suctioned out. The tympanostomy tube is then carefully inserted through the hole.

After Surgery:

Patients will spend about an hour in our recovery room before being discharged home. Antibiotic drops will be given for use in the operated ear(s) for a short period of time after surgery. While the tubes are present in the ear, it is advisable to avoid water exposure, as this may result in middle ear infections. Earplugs or a cotton ball soaked with vaseline should be used when bathing, while for swimming, ear plugs should be used. Should infection develop (draining ear) after water gets into the ear, eardrops and antibiotics will almost always cure the problem. Scuba diving is contraindicated when tympanostomy tubes are in the ear.

Risks of Surgery:

There are several risks associated with myringotomy plus insertion of tympanostomy tubes. One of ten children having tympanostomy tubes inserted will develop postoperative infection (draining from the ear). The reason for this infection is not clearly understood but it appears to be related to the type of fluid in the child's ear and occurs regardless of antiseptic measures used by the doctor. The infection can almost always be cured by eardrops and antibiotics but, rarely, the tubes may have to be removed to stop the drainage. Scarring may also occur on the eardrum as a result of tympanostomy tube insertion but this problem seems to be of little significance and rarely affects the patient's long-term hearing or health of the ear. Rarely, a hole may be left in the eardrum where the tube was inserted and, if necessary, this can be surgically patched. Anytime an anesthetic is used for surgery its risks are of concern. No permanent injuries to patients, however, have been reported from anesthetics used during tympanostomy tube insertion. Similarly, surgical complications during tympanostomy tube insertion (bleeding, increased hearing loss) may be of concern but are extremely rare.

In summary, tympanostomy tube insertion and the treatment of recurrent ear infections or fluid and pressure changes behind the eardrum is a safe and reliable therapy when employed by capable surgeons and competent anesthetists and anesthesiologists. The benefit of reducing ear infections and improving hearing is felt by the vast majority of ear doctors to outweigh the unusual but potential risks of surgery, anesthesia, and infection.