Ear Tubes Placement (Tympanostomy)

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the indications for ear tubes placement?

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.

What is a tympanostomy and ear tubes placement?

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.

What should I expect before surgery?

1. There is no special preparation before ear tubes placement. If you or your child has an active ear infection, you may take antibiotics and pain medication up to the date of surgery.
2. While our office will make every attempt to keep the patient’s primary care physician informed before and after your surgery, it is important that you personally inform him/her that you or your child is planning to have ear tubes placement.
3. Due to the frequently changing operating room schedule, the surgery center will usually call you one business day before your surgery date to inform you of your surgery time. Depending on the time of your or your child’s surgery, the center will instruct you on the specific time to stop feeding before surgery.

What should I expect during surgery?

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.

What should I expect after surgery?

1. Pain is minimal after ear tubes placement. If there is any residual pain, Tylenol and/or ibuprofen is usually adequate for pain control.
2. You or your child may continue to have some drainage from the ear, particularly with the use of ear drops. With each subsequent episode of ear infection after the ear tubes are placed, you may notice recurrent drainage from the ears. This is expected in the setting of an active ear infection and can help reduce the pressure and inflammation in the middle ear.
3. How long the ear tubes remain in the eardrum varies depending on which type of tubes are placed. On average, the short-acting tubes will remain in place for about one year. The tubes will usually get extruded spontaneously and you may notice it on the pillow once they’ve fallen out.
4. You will need to follow up 1-2 weeks after surgery and every 6 months thereafter for a tube check.

What are the risks of ear tubes placement?

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:

• Recurrence of disease: About 80% of children who required ear tubes will only need one set of tubes. However, a small subset of patients will develop recurrent infections after the first set of tubes have fallen out. As a result, repeat ear tubes placement may be needed down the line.
• Tympanic membrane perforation: After the tubes fall out, the hole in the eardrum will heal up spontaneously in the vast majority of patients with close observation. In rare cases which the perforation remains open, a patch can be performed to close up the drum.
• Retained ear tube: Most short-acting ear tubes will remain in place for about one year. In some cases, the tubes may get extruded much sooner. In cases which the tubes remain in place longer than expected without any recurrent infection, they can be removed with or without general anesthesia.

What restrictions will I have during the postoperative recovery period?

• You may fly without any restriction after ear tubes placement.
• Please maintain dry ear precautions for 7 days after surgery. Recent research suggests that there is no significant increase in risk with water exposure. However, each patient may have different susceptibility to ear infection with water exposure while the ear tubes are in place. In general, you or your child may swim in a clean pool without ear protection. You should try to protect the ears by using earplugs if you are diving, submerging in tub water, or swimming in a dirty body of water such as a lake, river, and ocean.

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.

References:

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2. Nesbit, C. E., and M. C. Powers. "An evidence-based approach to managing acute otitis media." Pediatric emergency medicine practice 10.4 (2013): 1-26.
3. Toll, Edward C., and Desmond A. Nunez. "Diagnosis and treatment of acute otitis media: review." The Journal of Laryngology & Otology 126.10 (2012): 976-983.
4. Rettig, Eleni, and David E. Tunkel. "Contemporary Concepts in Management of Acute Otitis Media in Children." Otolaryngologic Clinics of North America 47.5 (2014): 651-672.
5. Rosenfeld, Richard M., et al. "Clinical Practice Guideline Tympanostomy Tubes in Children." Otolaryngology--Head and Neck Surgery 149.1 suppl (2013): S1-S35.
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7. Kivekäs, Ilkka, and Dennis Poe. "Is there an optimal location for tympanostomy tube placement?." The Laryngoscope (2015).
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9. Lous, Jørgen, Christina T. Ryborg, and Janus L. Thomsen. "A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media." International journal of pediatric otorhinolaryngology 75.9 (2011): 1058-1061.
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11. Mikals, Samantha J., and Matthew T. Brigger. "Adenoidectomy as an adjuvant to primary tympanostomy tube placement: a systematic review and meta-analysis." JAMA Otolaryngology–Head & Neck Surgery 140.2 (2014): 95-101.