Myringotomy and Tubes ( Ear Tubes )
This web page is an attempt to help patients and families to understand the basic priciples of serous otitis media (fluid in the middle ear) and acute otitis media (infection in the middle ear). It is not meant to be all inclusive nor is it any form of guarantee. It is not meant to be a substitute for personal attention to your problems and questions.
The ear is divided into three parts. The outer ear is composed of the auricle and the ear canal. The middle ear is the space inside the tympanic membrane (eardrum) and includes the eustachian tube. The first bone is the malleus. The second is the incus. The third and smallest is the stapes. The inner ear is housed in the bone just inside the middle ear. This is where the nerve endings of hearing and balance are. The mastoid is the bone behind the ear. The brain lies above the middle and inner ear.
ACUTE OTITIS MEDIA AND SEROUS OTITIS MEDIA:
There are two frequent problems that bring you to my office in consideration of tubes. The first is frequent, persistent or unrelenting painful middle ear infections; that is, acute otitis media. The second is painless fluid behind the eardrum that is causing hearing loss; that is, serous otitis media.
Serous otitis media and acute otitis media are common problems in young children. The underlying cause is a malfunction of the eustachian tube which leads from the middle ear to the nasopharynx (the back of the nose). Factors such as the age of the patient, size of the eustachian tube, family history of ear problems, repeated upper airway infections, enlarged adenoids, recurrent tonsillitis, and allergy may contribute to the malfunction of the eustachian tube. Also, bottle fed babies have more ear problems, especially if they are allowed to take a bottle while lying down. This allows whatever they are drinking to go up their eustachian tube into the middle ear.
Acute otitis media (painful infection) does not usually cause permanent hearing loss or other complications if treated with antibiotics and/or decongestants. Often some children have repeated episodes of acute otitis media which necessitates efforts at prevention. One method of prevention is to place an incision in the eardrum (myringotomy) which is held open by a plastic or metal tube. This tube temporarily replaces the function of the eustachian tube and decreases the frequency of infection. The tube allows air to pass through it into the middle ear. This equalizes the pressure like the eustachian tube would if it were functioning normally.
Serous otitis media (fluid) may occur by itself or after a bout of acute otitis media. The fluid dampens the vibration of the tympanic membrane (eardrum). This causes a temporary hearing loss that, if persistent, can interfere with learning and speech development in children of any age to a significant degree. If you have ever had your ears totally plug up on an airplane, you know how these children feel most of the time.
Myringotomy and tubes is a temporary replacement of the function of the eustachian tube. The body's natural healing tendency pushes the tube out and the eardrum heals. At this point, the original problem may or may not return. Depending on the history and age of the patient, sometimes other measures, which might help prevent having to repeat the myringotomy and tube insertion are suggested. These additional measures, which may be done at the same time as the myringotomy and tubes, are adenoidectomy and/or tonsillectomy and/or allergy testing.
In summary, the two main benefits of myringotomy and tube insertion are: 1) Improved hearing, and 2) Less frequent painful ear infections.
There are risks to anything. Some of the risks in myringotomy and tubes are: 1) Anesthesia (being put to sleep), 2) Infection, 3) Bleeding, 4) Hearing loss, and 5) Possible permanent perforation (hole) of the eardrum. These risks are generally minimal.
No one has to have a myringotomy and tubes. Options are: 1) Do nothing, 2) Continue medications, 3) Hearing aids, 4) Allergy testing and treatment with appropriate medicines, 5) Myringotomy without tubes, and 6) Removal of tonsils and/or adenoids.
1) Patients MUST NOT eat or drink anything 6 to 8 hours before surgery until after surgery. Absolutely nothing! The usual instructions are nothing to eat or drink after midnight.
2) Preoperative laboratory tests are not generally required.
3) If only myringotomy and tube placement is planned, the patient will be done as an outpatient. This means he does not need to stay in the hospital overnight. The patient would come in early the day of surgery unless otherwise instructed and will be allowed to go home very soon after surgery. The exact time to arrive will be given to you.
WHAT IS DONE AT SURGERY:
Children are anesthetized (put to sleep) for a very brief period. Adults and adolescents may be done with local anesthesia (numbing of the ear). A myringotomy (cut) is made in the tympanic membrane. Fluid present in the middle ear is removed by suction. A plastic or metal tube is then placed in the myringotomy site. The tubes stay in place usually from 3 to 12 months. The longer they stay in place, the better. Almost always they are pushed back out by the body's natural healing. The myringotomy site heals to close the incision. If the tubes have not come out in 2 to 4 years, I may suggest removal.
If the adenoids and/or tonsils are removed, this is done through the mouth.
WHAT TO EXPECT AFTER SURGERY:
1) Parents are asked to stay in the Outpatient Waiting Room while the patient is in surgery. If I would like to talk with you, I will know where you are.
2) There may be some bloody drainage to the outer ear the first 1 to 3 days, but this should stop. If it does not stop, please call the office and inform the nurse.
3) Most patients have very little or no pain from myringotomy and tube placement.
4) Children having an adenoidectomy also have little discomfort. They usually complain of a headache and a stiff neck. They may eat anything they want.
POSTOPERATIVE HOME CARE:
1) Keep all water out of the patient's ear when bathing, washing hair, or swimming. Use either a cotton ball coated with Vaseline or custom-made earplugs. If you desire, earplugs can be made in the office. If the patient is a real good swimmer who is diving in and jumping in, a tight bathing cap should be worn over earplugs.
2) If any significant drainage occurs, make an appointment to be seen at the next convenient date.
3) Popping or cracking noises in the ears may occasionally be noticed. These are normal.
4) Generally, I want you to finish any course of antibiotics already started before surgery.
5) If Dr. Woods prescribes eardrops, occasionally they will burn for 10 to 30 minutes. If this happens, call the office for another type of drops.
Patients with tubes should be checked periodically until the tubes are completely out of the ears. I like to see you 7 to 10 days after your surgery. Then, if everything is going well, I need to see you at about 6 and 10 months after surgery. If any pain, drainage, or bleeding occurs, come in sooner.
If you have any additional questions or problems, please feel free to ask me or any of the office staff. We want satisfied and comfortable patients and families.
If you would like to be seen please call for an appointment.
(859) 276-4838 or (800) 432-0994