Tympanostomy tubes, commonly called ear tubes, are small, hollow cylinders placed in a child’s eardrum to treat persistent ear issues. This procedure, known as a myringotomy with tube insertion, is one of the most common outpatient surgeries performed on children. The tubes serve to ventilate the middle ear and prevent complications associated with chronic infection or fluid buildup.
Chronic Issues That Lead to Ear Tubes
The primary conditions prompting consideration of ear tubes are Recurrent Acute Otitis Media (AOM) and Chronic Otitis Media with Effusion (OME). AOM involves repeated, painful, and active ear infections where the middle ear space becomes inflamed and infected. These infections are often caused by bacteria or viruses traveling up the Eustachian tube, the canal connecting the middle ear to the back of the throat.
OME, commonly called “glue ear,” is the persistent presence of fluid in the middle ear without signs of active infection. When the Eustachian tube is blocked or dysfunctional, it prevents air from entering the middle ear and draining fluid. This fluid buildup prevents the eardrum from vibrating correctly, causing muffled hearing and increasing the risk of future acute infections.
When Are Ear Tubes Actually Necessary?
The decision to place ear tubes is based on specific, measurable criteria established in medical guidelines, usually related to the frequency of infection or the duration and severity of fluid. For Recurrent AOM, tubes are considered when a child experiences three or more distinct episodes within a six-month period, or four or more episodes within a twelve-month period, with at least one infection in the preceding six months. The child must also have middle ear fluid present when evaluated for tube candidacy.
For Chronic OME, the primary indication is fluid that has been present in one or both ears for three months or longer. A hearing test is strongly recommended when OME persists for this length of time to determine if the fluid is causing hearing difficulties. Tubes are offered if the child has bilateral OME for three months or more and documented hearing difficulties. Hearing loss of 25 to 30 decibels or greater often prompts surgical intervention.
Tubes may also be considered for children with chronic fluid and other symptoms likely related to OME, such as balance problems or behavioral issues. Children with conditions like Down syndrome or cleft palate are considered “at-risk” and may be evaluated for tubes sooner. The goal is to prevent potential long-term issues like speech or language delays that can occur from prolonged hearing impairment.
What Happens During the Tube Placement Surgery?
The procedure, known as tympanostomy, is a brief, outpatient surgery that usually takes less than fifteen minutes to complete. In children, it is typically performed under general anesthesia, administered via a mask, to ensure the child remains completely still and comfortable during the delicate operation. General anesthesia is preferred because it is difficult for young children to remain immobile during the microscopic work required.
The surgeon uses a microscope to visualize the eardrum and creates a small incision, called a myringotomy. If fluid is present behind the eardrum, it is suctioned out through this opening. A small, hollow tube, often made of plastic or metal, is then inserted into the incision. This tube immediately equalizes the pressure in the middle ear, allowing air to flow in and preventing future fluid accumulation.
Life After Tube Placement
Recovery from ear tube placement is fast, and most children can return to normal activities the day after surgery. The child may be tired or slightly off-balance for the rest of the day due to the anesthetic. Mild pain is manageable with over-the-counter pain relievers.
Parents may notice clear or yellowish drainage from the ear for a few days as trapped fluid drains out. Antibiotic ear drops are often prescribed for a short period after the procedure to prevent infection. Earplugs are generally not necessary for surface swimming in clean, chlorinated pool water.
The tubes are temporary and are naturally pushed out of the eardrum as it heals, a process called extrusion. Tubes typically remain in place for six to twelve months before falling out. The eardrum then naturally closes where the tube was located. Regular follow-up appointments are necessary to monitor the tubes and check the child’s hearing until extrusion is complete.