Ear Tube Surgery (Myringotomy Tubes) - Indications    
Click on colored text for word definitions !!

WHAT ABOUT COMING TO THE HOSPITAL?                      Click on Pictures to Enlarge

It is VERY IMPORTANT on the day of surgery, that your child have an empty stomach.  If anything has been put into the mouth or stomach, because of SAFETY for your child, the surgery must be cancelled. Even chewing gum will cause the cancellation of surgery. DO NOT let your child eat or drink ANYTHING on the day of surgery.  Please tell someone if you think your child has eaten or has drank anything on the day of surgery.  If there is food or liquid in the stomach at the time of surgery, there is a chance your child could choke while asleep.

Putting in tubes takes only a few minutes, but because the child must hold still, and might otherwise feel pain, the procedure is done with the child asleep in the operating room.  If your child is cooperative, the tubes may be placed in the doctor's office under light sedation. Using a microscope, a small opening is made in the eardrum and any fluid behind it is suctioned out.  The small tube is then put in.        Click on Pictures to Enlarge

Video of Ear Tube Surgery Reset Download Speed      
Search PubMed for Myringotomy Tubes

Ear (Myringotomy) Tubes - After The Surgery:
  
Will an ear tube need to be inserted if my child's tube comes out ???              Click on Pictures to Enlarge

The reinsertion rate for ear tubes is between 15.9 % (Age over 18 months)  to 26.3 % (age 18 months or younger.)   The greatest risk factor for reinsertion is a patient whose age is less than 18 months (3).   It is very important that your child has checkups every 3 to 6 months after the tubes are put in so the tubes can be checked to determine it they are still working.

Most tubes stay in place for 3 to 18 months, average is 9 months, however, they can come out sooner or stay in longer.  However, this varies widely between patients. View Article  They usually come out on their own and the drum usually heals. The first sign that the tube is coming out is that it becomes plugged.  This is caused by the eardrum healing behind the tube. The tube will then be slowly pushed out.  

Many ENT Doctors feel that non-chlorinated water getting into the ear can cause middle ear infections.  Because of this many ENT Doctors will recommend wearing water ear plugs when bathing or swimming.  In a recent article Goldstein et. al. supports the use of water precautions in children who have have had ear tube placement.  View Article
 
Click on Pictures to Enlarge

  
Sometimes bleeding occurs when the tubes are coming out.  The use of ear drops usually stops the bleeding and allows the tubes to come out naturally. If the tubes stay in for 3 years your doctor may want to remove them by taking your child back to the operating room. Rarely (1%), a hole is left in the eardrum when the tubes come out.  This hole will act as a tube, but at some point the child will have to be taken back to the operating room and have the hole patched.  This procedure may be postponed until the child is 6 to 8 years of age.

It is very important that your child has checkups every 3 to 6 months after the tubes are put in so the tubes can be checked to determine it they are still working.

   
When tubes stop working it is usually because they have become plugged or the eardrum has healed behind the tube.  If the ear tube is plugged it often can be unplugged in the office.  However, if the eardrum has healed behind the tube and the tube is still needed, then tube reinsertion may have to be performed.  

The pictures to the right shows plugged ear tubes with an acute otitis media (middle ear infections).

      Click on Pictures to Enlarge

This picture shows an ear tube with pus draining out of it in a child with an acute otitis media (middle ear infection).  Up to one third of infections in ears with ear tubes is due to a bacteria called pseudomonas.  This bacteria is resistant to almost all oral antibiotics which can be given to children.   If ear drops do not clear the infection, the child may rarely have to be placed on IV medications through home health.   Treatment with ear drops containing neomycin have the potential for ototoxicity, but have been used for many years with few adverse effects.  View Abstract   View Abstract   A new generation of ear drops which contain fluoroquinolone antibiotics ( cipro and floxin ear drops ) are also effective against pseudomonas and are not ototoxic.  View Abstract 

Rarely an ear tube does not fall out into the ear canal but instead falls into the middle ear.  Usually, this does not cause a problem and the tube does not have to be removed.

The two pictures on the right shows ear tubes which have migrated into the middle ear. 

 

Click on Pictures to Enlarge
 

This 80 year old patient had a nasopharyngeal (back of the nose) mass which presented with blockage of the eustachian tube and serous otitis media ( ear fluid ).  The mass was a benign cyst (Tornwaldt's Cyst) but could have been a cancer.  Older patients that present with persistent ear fluid should have an examination of the nasopharynx.

    Click on Pictures to Enlarge

This picture shows an infected ear tube with pus draining out of the tube and an infectious granuloma above the ear tube.

     Click on Pictures to Enlarge

This picture is of a 12 year old who had ear tubes placed six years ago.  Granulation tissue has completely grown over and enveloped the tube.  The ear had chronic drainage from the granulation tissue.  The eardrum was mobile and the ear tube was plugged with tissue.   Surgical tube removal will probably be required. 
 
 
 
  Click on Pictures to Enlarge
 
 
 
   
 
The picture on the right shows a perforation from a myringotomy tube.  Eardrum perforations occur in about 2% of ears.  View Abstract

     Click on Pictures to Enlarge

    
  
  
 
This picture shows an eardrum with tympanosclerosis or white plaques of the eardrum which form from prior infections.     The plaques are surrounding a "monolayer" or thin portion of the eardrum.  Not how through the hand held otoscope the monolayer mimics a perforation but the close up view clearly shows the intact eardrum.  A monolayer is sometimes occurs when an eardrum perforation heals.  In this patient the monolayer formed after an ear tube extruded.    Click on Pictures to Enlarge

  
The picture on the right shows a picture of an ear with an acute otitis media ( middle ear infection ) with an extruded ear tube, laying in the ear canal.

The picture on the left shows a perforation and a granuloma which formed from an ear tube
  
  
  
   
    
This child was referred to our practice with a very rare complication.  The ear ( myringotomy ) tube fell into the middle ear and down the eustachian tube.  The child developed a cholesteatoma.  Treatment consisted of a canal wall down mastoidectomy and removal of the myringotomy tube from the eustachian tube.