Myringotomy and Tubes ( Ear Tubes )
PURPOSE:
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.
ANATOMY:
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.
RISKS:
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.
TREATMENT OPTIONS:
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.
BEFORE SURGERY:
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.
FOLLOW-UP:
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.
QUESTIONS:
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
|