Ear tubes, formally known as tympanostomy tubes or pressure equalization (PE) tubes, are tiny medical devices used to treat chronic ear conditions. Their purpose is to manage recurrent middle ear infections (acute otitis media) or persistent fluid behind the eardrum (otitis media with effusion). Inserting these tubes is one of the most common surgical procedures performed on children to restore normal hearing and reduce the frequency of painful infections.
The Physical Appearance of Ear Tubes
Tympanostomy tubes are small, designed to fit within the eardrum. Most short-term tubes, often called grommets, are less than two millimeters tall. Their design is generally cylindrical, resembling a tiny spool or bobbin with a central opening and flanges on either end to hold the tube in place.
The tubes are manufactured using biocompatible materials, most commonly fluoroplastic, Teflon, or silicone elastomers. While some long-term designs use metals like titanium, plastic-based tubes are widely favored. These materials give the tube a translucent, white, or slightly colored appearance (sometimes blue or green) when viewed through an otoscope.
The tube is inserted into a small surgical opening in the eardrum, called a myringotomy site. When viewed through the ear canal, the tube appears as a small, shiny object positioned flat against the eardrum. The central hole is visible, providing a direct passage to the middle ear space.
Function and Purpose of Ventilation
The need for a tube arises when the Eustachian tube, the ear’s natural ventilation system, is not working correctly. The Eustachian tube connects the middle ear to the back of the throat, equalizing pressure and draining fluid buildup. When this tube is dysfunctional, often due to swelling or immaturity in children, it causes negative pressure in the middle ear space.
This negative pressure causes the eardrum to retract and the middle ear lining to secrete fluid, resulting in “glue ear.” The tympanostomy tube creates an alternate airway, acting as a vent that bypasses the malfunctioning Eustachian tube. By maintaining an open connection between the outer ear canal and the middle ear, the tube ensures air pressure is constantly equalized.
This constant ventilation allows trapped fluid to drain out of the middle ear and prevents new fluid accumulation. Equalizing the pressure and clearing the fluid restores normal hearing, which is dampened when sound waves cannot pass through the fluid-filled space. The tube also provides a pathway for medicated eardrops to reach the site of infection directly if one occurs.
Insertion Procedure and Tube Lifespan
Ear tube insertion is an outpatient procedure called a myringotomy with tube placement. It is typically performed in a hospital or surgery center under general anesthesia, especially for children, to ensure stillness. During the procedure, which usually takes about 15 minutes, the surgeon creates a small incision in the eardrum.
Any fluid present in the middle ear is suctioned out through this opening before the tympanostomy tube is placed. The goal is to establish a passage that remains open long enough for the child’s Eustachian tubes to mature and function normally. The tube’s lifespan varies significantly depending on its design, which is categorized into two main types.
Short-Term Tubes
Short-term tubes, like the grommet style, are temporary, with a typical retention time of 6 to 18 months. These tubes are spontaneously extruded by the eardrum as the tissue heals and migrates outward.
Long-Term Tubes
Long-term tubes, such as the T-tube design, have larger flanges and remain in place for 15 months or longer. These sometimes require a minor procedure for removal. Once the tube falls out, the opening usually closes and heals on its own, though some patients may require surgical repair if the perforation persists.