FREQUENTLY ASKED QUESTIONS
Myringotomy (Ear) Tubes
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WHAT ARE TUBES?
Myringotomy
tubes are small tubes placed into the eardrum to help ventilate
the middle ear and prevent recurrent ear infections. They are
the size of a pen tip and are typically made of silicone, flouroplastic
or titanium.
WHY ARE THEY NEEDED?
Tubes are
placed when a child has recurrent or chronic ear infections (otitis media).
Up to 90% of children will get an ear infection in their first few years of
life. Tubes are recommended when a child experiences:
- 4 or more ear infections within 6 months
- 7 or more infections within a year
- 3 or more infections a year for 3 years
- persistent ear fluid lasting 3 months or more
- recurrent otitis with speech delay
- cleft palate or other craniofacial anomalies and have persistent
fluid
DOES MY CHILD NEED ANESTHESIA?
Yes. This
is an outpatient procedure that takes 5 minutes to perform.
IS IT SAFE?
Yes. Tube placement is the 2nd most common surgical procedure
performed (circumcision #1) worldwide. It requires only masked
anesthesia. NO IV OR BREATHING TUBE is
needed. I work with pediatric anesthesiologists who
have extensive training/experience giving children anesthesia.
HOW DO YOU DO IT?
The procedure
is performed in the operating room with masked anesthesia under a microscope.
A very small incision is made in the eardrum and the tube is placed.
HOW LONG DO THE TUBES STAY IN?
Typically
the tubes remain in the eardrum about one year. They may fall
out earlier and sometimes they stay in place 18-24 months. The eardrum usually
sheds the tube. Occasionally the tubes need to be removed, but usually only
if there is chronic drainage or if the tubes haven’t fallen out after
2 years and the child has not had an infection in the prior 10-12 months.
DO YOU TAKE THEM OUT IN THE OFFICE?
No. I remove
them in the operating room. Tube removal can be painful and I patch the eardrum
at the time of removal.
WHAT ARE THE RISKS?
The biggest
risk is that the tubes leave a hole in the eardrum when they fall out. This
is very uncommon, occurring less than 1-2% of the time.
If there is a residual hole (perforation) I will perform a patch
procedure, which requires only masked anesthesia. This typically
works 90% of the time. If that fails, a more formal eardrum repair
(tympanoplasty) is performed.
Other risks
include chronic ear drainage and cholesteatoma (an ingrowth of outer eardrum
skin into the middle ear). Both of these are very infrequent complications,
occurring in my practice less than 1% of the time.
The following are other risks that rarely occur:
- Failure to resolve the ear infections.
- Thickening of the eardrum over time, which affects hearing
in a small percentage of patients, and usually is due to recurrent
infections.
- Persistent perforation after the tube falls out of the eardrum.
- Need for further and more aggressive surgery such as tonsil,
adenoid, sinus, or ear surgery.
- Hearing loss, usually due to a residual ear drum perforation
- Scarring of the eardrum
- Possible need to keep the ear dry and to use ear plugs, see
below
- Foreign body reaction to the tube itself - for example, an
allergic reaction to the tube material (rare), causing chronic
ear drainage
WHAT IF MY CHILD HAS AN EAR INFECTION
AT THE TIME OF SURGERY?
No problem.
I will drain any fluid that is behind the eardrum at the time of surgery.
WHAT
IF MY CHILD IS SICK BEFORE THE PROCEDURE?
Unless you
child has a fever greater than 100.5 F or has a significant cold
with a wet cough, the procedure usually can be performed. If your child has mild
symptoms of illness, I usually recommend that you keep your surgery appointment,
and be evaluated by the anesthesiologist on the day of surgery. Occasionally
the surgery is cancelled at this time by the anesthesiologist, but this is infrequent.
If there are any questions, call the office.
WHEN CAN MY CHILD GO BACK TO NORMAL ACTIVITY?
Your child
may be fussy the day of surgery, usually due to the anesthesia, but otherwise
he/she can resume normal activities the day after surgery.
WHAT IS THE POST-OPERATIVE CARE?
I will give
you ear drops the day of surgery. You are to use the ear drops after
surgery by placing 3 drops in both ears 3
times a day for 3 days. I also give you a prescription
for more ear drops. I recommend you fill this prescription and put the extra
drops in your medicine cabinet. The drops are good for a year.
CAN MY CHILD’S EARS GET WET?
Yes, your
child can get their ears wet in the bath but there are some restrictions. See
below.
DO THEY NEED EAR PLUGS?
No, ear
plugs are not needed unless the child is going to be swimming in dirty water
(lakes, rivers, ponds or streams) or diving more that 4 feet underwater in
the pool. Otherwise the pool and clean bath water are fine. If your child wants
to play in the bath, let them play in clean water. Once you soap and clean
your child, do not submerge the head in the soapy, dirty water.
WHAT DO I DO IF MY CHILD GETS AN EAR INFECTION?
If your
child has an ear infection, you will see drainage from the ear canal, usually
looking like snot. If you see this, use the ear drops as prescribed for 1 week.
Your child does NOT need oral antibiotics for ear drainage. The concentration
delivered by the drops to the site of infection is 1000-fold greater than what
you get with oral antibiotics.
If you are using the drops and there is still drainage
after 5-6 days, call the office. This occurs rarely,
but if so, I will prescribe oral antibiotics in addition to the
drops.
If the drainage
is thick and you cannot get the drops in, use a blue bulb syringe to
suction out the drainage so you can get the drops in. Place the tip of
the syringe just inside the ear canal and suck out the drainage. You can also
use the syringe to gently irrigate the ear canal with salt water (1 teaspoon
of iodized salt in 8 oz. of water).
WHEN DO I FOLLOW UP IN THE DOCTOR’S OFFICE?
I would
like to see your child back in the office 3 weeks after surgery and
then at about a year after surgery to check the tubes. |
