Myringotomy Tubes

Myringotomy Tubes

What are myringotomy tubes (also called ear tubes, tympanostomy tubes, or ventilation tubes)?

Myringotomy tubes are small tubes that are surgically placed into your child's eardrum by an ear, nose, and throat surgeon. The tubes may be made of plastic, metal, or Teflon®. The tubes are placed to help drain the fluid out of the middle ear in order to reduce the risk of ear infections. During an ear infection, fluid gathers in the middle ear, which can affect your child's hearing. Sometimes, even after the infection is gone, some fluid may remain in the ear. The tubes help drain this fluid, and prevent it from building up. The most common ages are from one to three years old. By the age of five years, most children have wider and longer eustachian tubes (a canal that links the middle ear with the throat area), thus, allowing better drainage of fluids from the ear.

Who needs ear tubes?

The insertion of ear tubes may be recommended by your child's physician and/or a ear, nose, and throat physician if several of the following conditions are present:

• fluid in the ears for more than three or four months following an ear infection
• fluid in the ears and more than three months of hearing loss
• changes in the actual structure of the eardrum from ear infections
• a delay in speaking
• repeated ear infections that do not improve with antibiotics over several months

What are the risks and benefits of ear tubes?

The risks and benefits will be different for each child. It is important to discuss this with your child's physician and surgeon. The following are some of the possible benefits that may be discussed:

• Ear tubes help to reduce the risk of future ear infections.
• Hearing is restored in some children who experience hearing problems.
• Speech development is not harmed.
• Ear tubes allow time for the child to mature and for the eustachian tube to work more efficiently. (By the age of 5 years, the eustachian tube becomes wider and longer, thus, allowing for better drainage of fluids from the ears.)
• Children's behavior, sleep, and communication may be improved if ear infections were causing problems.

The following are some of the risks that may be discussed:

• Some children with ear tubes continue to develop ear infections.
• There may be problems with the tubes coming out:
  • The tubes usually fall out in about one year. After they fall out, if ear infections recur, they may need to be replaced.
  • If they remain in the ear too long, the surgeon may need to remove them.
  • After they come out, they may leave a small scar in the eardrum. This may cause some hearing loss.
• Some children may develop an infection after the tubes are inserted.
• Sometimes, after the tube comes out, a small hole may remain in the eardrum. This hole may need to be repaired with surgery.

How are ear tubes inserted?

Myringotomy is the surgical procedure that is performed to insert ear tubes. Insertion of the tubes is usually an outpatient procedure. This means that your child will have surgery, and then go home that same day. Before the surgery, you will meet with different members of the healthcare team who will be involved in your child's care. These may include:

• nurses - day surgery nurses prepare your child for surgery. Operating room nurses assist the physicians during surgery. Recovery room (also called the Post-Anesthesia Care Unit) nurses care for your child as he/she emerges from general anesthesia.
• surgeon - a physician who specializes in the placement of the tubes.
• anesthesiologist - a medical physician with specialized training in anesthesia. He/she will perform a history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you and your questions will be answered. Insertion of myringotomy tubes requires general anesthesia in children.

Myringotomy involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months. Your child's recovery will be monitored closely. Your child must meet all discharge criteria in order to go home. Follow-up care is needed for your child based on the surgeon's recommendations. Usually, you will return in about two to four weeks, then four to six months after the tubes have been inserted, and then approximately one year later. Your child's physician will help manage the care of your child in between these visits, in agreement with the surgeon.

Care of the child after the ear tubes are inserted:

The following are some of the instructions that may be given to you following the placement of ear tubes in your child:

• Your child's surgeon may order antibiotic ear drops to be placed after the initial insertion of the tubes, to prevent infection.
• You will be instructed to call your child's physician if your child experiences any of the following symptoms:
  • drainage from the ear
  • ear pain
  • fever
  • myringotomy tube displaced (out of ear)
• You will be instructed on the use of earplugs while your child is in the water, based on the opinion of your child's physician. Different physicians have different recommendations regarding the use of earplugs.

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