What Are "Tubes in the Ear"?

Mark Chu-Caroll related a story in the comments to this post, about how his son benefited greatly from having tubes put in his ears after recurring ear infections became a serious issue.

For children who get frequent ear infections, tympanostomy tubes can be a very effective, and low-impact treatment. (An explanation of ear infections, and how they occur, is here.) A small tube is inserted into the eardrum, which allows the built-up fluid that has accumulated behind the eardrum to drain out. It also allows air to once again permeate the middle ear, and helps prevent further infections.

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This procedure does require that a small hole is made in the eardrum, although this hole heals naturally with 2 weeks and does no permanent damage to hearing. Anesthesia is used because it is imperative that the patient lie completely still (impossible for a 2 year old with an ear infection!).


The procedure is now commonly performed with a laser-system, such as the one pictured above. The diameter of the laser beam can be precisely selected in incremental steps of 0.1 mm, which is related to the length of time the hole remains open. Here is a video of the surgical procedure to puncture the ear drum (called a myringotomy) and here's one of tube insertion---very interesting!

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Good pediatricians know that :-). Our pediatrician, who is absolutely wonderful, spent about 10 months trying to clear his ear infections. We gave it plenty of time; but for almost a full year, the fluid behind his ears *never* drained. When he showed signs of serious hearing impairment and speech delay, she sent us to an ENT who did the tubes.

It's definitely something that shouldn't be a first resort. But when it's needed, it's absolutely amazing.

Wow, I had tubes by the time I was 3 or 4. Had them again at 7 or 8, generating a roughly 15% hearing loss. Had to seal a perforation in order to get into the Army, where, as an artillery soldier my eardrums were subjected to routine concussions and generating a hearing loss of 15 - 20 %. I sit at 30% loss right now (Army wanted me back but I couldn't pass the hearing test LOL).

I've always hoped that some of my hearing loss was reversible. Roughly 10 years ago I learned that loss generated by repeated heavy concussions might produce a ringing in the ear - indicating that some of my loss was range specific (depending on the range of the percieved tone). I think we all learned recently that ringing of the ears, tinitis, might also be partially a neurological disorder or damage. This gave me hope because our knowledg of the brain and the chemicals which affect it is growing rapidly, meaning I might be able to find relief with some type of supplement or drug very soon. There seems to be particular interest in the audio memory cortex (can't get that annoying song out of your head? Give your brain a drink of water, you're dehydrated!) and its place in our evolutionary history.

I always take Omega 3s(which are supposed to generate neuronal strength, right?), and I tried Vitamin A for the tinitis a couple of years ago (did not work). Maybe soon they will be able to specifically target any neurons which might be over firing or even "stuck in the on position" in the audio memory cortex and reduce the effects of tinitis.

I'm sure Shelley will keep us posted ;-)

I want to second Mr. Chu-Carroll's statements here: as someone who's legally deaf, sometimes tubes are the only option. Sometimes, one set isn't enough. I had fourteen (approximately). One thing to mention (though I don't know if this is the case with the laser): sometimes the holes become permanent. (They attempted to correct the problem when I was 17, but the tympanoplasty didn't take.)

Something happened to a couple of my clauses there. (That'll teach me not to prevew.) What I meant to write was "as someone who's legally deaf as a result of tubes, I still want to say that sometimes they're the only option." That takes care of the hole in my sentence; now I'm off to take care of the one in my brain.

I'll put a word in as a pediatrician and the father of four daughters, one of whom had myringotomy tubes placed.

First, let me say that the article referenced by Doug in the first comment to this post refers to ACUTE OTITIS MEDIA (AOM) - an acute middle ear infection. The option of "watchful waiting" as described in that article is fully endorsed by the American Academy of Pediatrics and the American Academy of Family Physicians. With an ACUTE infection, you can wait 48 hours before initiating antibiotic therapy if the tympanic membrane is not bulging and the patient is not in significant pain. Often the ear infection will clear and antibiotics won't be necessary. This is an important option since AOM is the number one reason antibiotics are prescribed to children, likely contributing to the emergence of antibiotic resistant strains of common bacterial pathogens.

Mr. Chu-Carrol sounds like he got good advice and care for his son. The primary indication for myringotomy tube placement is hearing loss and speech delay due to chronic OTITIS MEDIA WITH EFFUSION, a different entity than AOM. It doesn't matter if the fluid is caused by viruses or not ... if hearing loss is present, problems can result. The most vulnerable time period is the 2-3 year old range when language and speech are developing with amazing rapidity. Kids with hearing loss during this critical time period risk significant speech & language delays.

However, like any surgical procedure, there are risks. Multiple tube placements can result in tympanosclerosis, scarring of the tympanic membrane, resulting in some hearing loss (usually mild). Sometimes, as in Mr. Kaufman's case, the tympanostomy does not close once the tubes come out, requiring tympanoplasty to seal it shut. The biggest risk, as in most minor procedures, is the risk of general anesthesia.

Sometimes adenoidectomy accompanies myringotomy tube placement. The adenoids, a lymphoid organ similar to the tonsils, often become enlarged due to the frequent viral infections of childhood. Since the adenoids are in close proximity to the Eustachian tubes, this hypertrophy can result in blockage of the Eustachian tubes and contribute to accumulation of fluid in the middle ear. ENT's will often recommend adenoidectomy along with MT placement. The clinical efficacy of this procedure is +/- ... often the adenoid tissue grows back after a short reprieve. However, sometimes that's enough to get you through that period of rapid language development.