Middle Ear Infections and Ear Tube Surgery (page 2)

Why Surgery?

Many kids get middle ear infections (otitis media, or OM), usually between the ages of 6 months and 2 years.

Some kids are particularly susceptible because of environmental and lifestyle factors (like attendance at a group childcare, secondhand tobacco smoke exposure, and taking a bottle to bed).

Although these infections are relatively easy to treat, a child who has multiple ear infections that do not get better easily or has evidence of hearing loss or speech delay may be a candidate for ear tube surgery.

During this surgery, small tubes are placed in the eardrums to ventilate the area behind the eardrum and keep the pressure equalized to atmospheric pressure in the middle ear.

About Otitis Media

The middle ear is an air-filled cavity located behind the eardrum. When sound enters the ear, it makes the eardrum vibrate, which in turn makes tiny bones in the middle ear vibrate. This transmits sound signals to the inner ear, where nerves relay the signals to the brain.

A small passage leading from the middle ear to the back of the nose — called the eustachian tube — equalizes the air pressure between the middle ear and the outside world. (When your ears pop while yawning or swallowing, the eustachian tubes are adjusting the air pressure in the middle ears.)

Infection

Bacteria or viruses can enter the middle ear through the eustachian tube and cause an infection — this often occurs when a child has had a cold or other respiratory infection. When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is bacterial.

Pressure from this buildup pushes on the eardrum and causes pain, and because the eardrum cannot vibrate, the child may experience a temporary decrease in hearing.

With treatment, a bacterial infection can be quickly cleared up. In most kids the fluid will resolve over time and hearing will be restored. Some research suggests that long periods of hearing loss in young children can lead to delays in speech development and learning.

Tympanostomy Tube Surgery

If your child is old enough to understand what surgery is, talk about what happens during ear tube surgery:

• Because your child will receive general anesthesia, the surgery will be performed in a hospital so that an anesthesiologist can monitor your child. The procedure takes about 10 to 15 minutes.
• The surgeon will make a small hole in the eardrum and remove fluid from the middle ear using suction. Because the surgeon can reach the eardrum through the ear canal, there is no visible incision or stitches.
• The surgeon will finish by inserting a small metal or plastic tube into the hole in the eardrum.

Afterward, your child will wake up in the recovery area. In most cases, the total time spent in the hospital is a few hours. Very young children or those with significant medical problems may stay longer.

After Surgery

A tympanostomy tube helps prevent recurring ear infections by allowing air into the middle ear. Other substances, including water, may sometimes enter through the tube, but this is rarely a problem. Your surgeon might recommend earplugs for regular bathing or swimming.

In most cases, surgery to remove a tympanostomy tube isn't necessary. The tube usually falls out on its own, pushed out as the eardrum heals. A tube generally stays in the ear anywhere from 6 months to 18 months, depending on the type of tube used.

If the tube remains in the eardrum beyond 2 to 3 years, however, it probably will be removed surgically to prevent a perforation in the eardrum or accumulation of debris around the tube.

Although effective in reducing chronic ear infections, ear tubes are not always a permanent cure for otitis media. Up to 25% of kids who need ear tubes before the age of 2 may need them again.

Reviewed by: Robert C. O'Reilly, MD
Date reviewed: October 2011