Ear Infections and PE Tubes (Ear Tubes)

 

Middle Ear: This is the part of your ear that is behind your eardrum. An infection of this space is what most people mean when they say “ear infection”. It is an enclosed space that connects to the back of your nose by a tube called the Eustachian tube (ET). This tube is normally closed at rest and opens when you chew. You can open this tube yourself by pinching your nose, closing your mouth and blowing. You feel your ear pop and that is your eardrum moving. The ET is the cause of your ear infections. It is not working properly. This is most common in children, as the ET is “immature.”

Adenoids: These are the tonsils in the back of your nose. They have been shown to potentially contribute to middle ear problems. This is due to its proximity to the ET opening in the back of the nose. We will usually recommend their removal in kids over 3 years of age concurrently with tubes if chronic middle ear infections are occurring.

Eustachian tube (ET): As mentioned above, your Eustachian tube connects your middle ear to the back of your nose. This tube has three important functions:

  • Pressure equalization – keeps the middle ear pressure the same as the environmental pressure. This is why you need to chew gum when going up in a fast elevator in a tall building. The chewing opens the ET and allows the pressure to equalize.
  • Drainage – allows secretions that are produced in the middle ear to drain into the nose.
  • Protection – the nose normally has some bacteria while the middle is normally a sterile place. As the ET is normally closed it prevents reflux of bacteria into the middle ear.

PE (Pressure Equalization) Tubes:

These tubes take over the function of the ET. The tubes are placed in the operating room in children and in the office in cooperative adults. The procedure takes just several minutes to perform. There are no external incisions. An incision is made in the eardrum. Any fluid is suctioned, then a tube is placed that spans the eardrum. The tubes usually stay in for about a year and fall out on their own. During this time you (or your child) will not be able to swim in non-sterile water (oceans, lakes or rivers) or put their head underwater in the bathtub unless wearing earplugs. Noncompliance with this is one of the main causes of continued ear infections. Swimming in a chlorinated treated pool has been shown to be safe in large studies.  However, the caveat is that if your child is having chronic drainage, swimming may have to be avoided until the tubes come out or are removed. 

You will now “know” when you or your child has an ear infection as you will see/smell the drainage coming out of the ear. In patients who need multiple sets of tubes a longer lasting tube may be placed. The main risk specific to the surgery is once the tube comes out that a hole remains (persistent perforation). This is about 1-5%. (If this occurs another procedure may need to be done to close the perforation.) This procedure has a high success rate of decreasing/stopping your ear infections. A concurrent adenoidectomy may or may not be recommended. If the tube stays in place for over two years we recommend removing them, as the rate of persistent perforation begins to increase after this point over the 1-5% rate.

Postoperative Instructions: Myringotomy with Tubes

  • Discomfort:  Pain is usually not a problem after tube insertion. Tylenol® may be given to handle any discomfort, which generally won’t last more than the day of surgery.
  • Drainage:  Drainage is normal after tube insertion, and usually tapers within a few days of surgery. Bloody drainage is not uncommon either.
  • Ear Plugs: While the tubes are in the ear, they need to be kept dry for at least one week following surgery.  You can resume swimming in chlorinated water after this time period.  Ear plugs or Vaseline® soaked cotton balls need to be used for baths or any other type of water.  Earplugs are available at our office or at most drugstores, and due to the low cost, we recommend trying them first. If they don’t fit well, then custom earplugs can be fitted by our audiologists.  Please contact our office for more information.
  • Ear drops: Eardrops will be given to you after the surgery. Typically, 3 drops are given 3 times a day for 3 days.  The ear canal is not straight, so for children, pull the ear down and back to straighten the canal before placing the drops. You can also push on the cartilaginous structure in front of the ear canal to make sure the drops reach deep in the ear.
  • Diet: Normal diet may and should be resumed following surgery.
  • Fever:  Contact our office with any temperature of 102º or higher.
  • Follow-up:  Follow-up in about 4 weeks after surgery.  After this, we will see you back every 6 months.  If any questions or concerns arise, please contact our office.