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Otitis media is a common infection of childhood, affecting about 62% of children by the age of one, 85% of children by the age of three, and nearly 100% of children by the age of five. Ear tubes are typically indicated in patients who develop multiple recurrent ear infections or chronic infections with associated hearing loss or speech/language delay. Ear tubes can decrease the frequency of ear infections and the use of oral antibiotics. In most of these cases, ear tubes allow for treatment of a middle ear infection with topical drops. About 80% of children who require ear tubes will only need one set of tubes. A small subset of patients will continue to develop chronic ear infections and Eustachian tubes dysfunction in adulthood. As a result, ear tubes placement in adults can be performed for similar indications.
Otitis media. Source: New England Journal of Medicine.
Tympanostomy and ear tubes placement is a procedure in which a small incision is made in the eardrum and a small tube is inserted to ventilate the middle ear until the Eustachian tube is able to function appropriately. In adults who can sit still, the tubes can be inserted in the office with a topical numbing medication. In children, the tubes are often inserted under anesthesia to avoid injury to the inner ear from sudden movement.
Given the short duration of the procedure, gas anesthetic is typically used via the face mask for anesthesia. A microscope is used to view the eardrum. A small 1-2 mm incision is made in the eardrum and any fluid that is encountered is suctioned out. A small ear tube is inserted into the eardrum at the incision site, which remains in place to ventilate the middle ear. A variety of different tubes can be used, depending on the goal of treatment. The tubes are about the size of the tip of a BIC pen. In general, a short-acting tube is used for the first set of ear tubes placement. Antibiotic ear drops are usually placed and the patient is then awakened.
Relative size of an ear tube to a dime
If the ear tubes are placed under anesthesia, the surgical team will include your child’s surgeon, an anesthesiologist, a scrub nurse, a circulating nurse, and additional supporting staff dedicated to ensuring that your child’s surgery is safe. The procedure usually takes about 5-10 minutes to perform; however, the whole process may take up to 30 minutes for transport and anesthesia induction. Your child will be asleep and will not feel any pain during the procedure. In general, the blood loss from ear tubes insertion is minimal (less than one drop).
In adults, the tubes are usually inserted in the office while awake. You may have some discomfort when the topical anesthetic is applied and when the incision is made. However, most adults tolerate the procedure well without any significant or lingering discomfort.
Schematic of a tube placement. Source: Adapted from Medline
As with any surgical procedure, ear tubes placement has associated risks. With meticulous planning and appropriate precautions, complications from ear tubes placement are rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. These risks may include:
What restrictions will I have during the postoperative recovery period?
Your surgeon is committed to providing you and your family with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of you or your child’s condition and treatment. Please feel free to ask questions about any aspect of your care. Learn more about ear infection or post-operative care after ear tubes placement.