Painful ear infections are a rite of passage for children—by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior, and speech problems. Inserting ear tubes may:
- Reduce the risk of future ear infection;
- Restore hearing loss caused by middle ear fluid;
- Improve speech problems and balance problems; and
- Improve behavior and sleep problems caused by chronic ear infections.
Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes.
These tubes can be made out of plastic, metal, or Teflon and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short- term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal is often necessary.
WHAT IS SURGERY LIKE FOR EAR TUBES?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy.
A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This done under a surgical microscope with a small scalpel (tiny knife). If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).
For children, a light general anesthetic is administered. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops are administered after the ear tube is placed and are recommended for a few days after the procedure. The procedure usually lasts less than 15 minutes.
Sometimes, in children, we will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery in certain age groups.
WHAT HAPPENS AFTER SURGERY?
Your child will be monitored for about an hour and will then be able to go home if no complications occur. Children usually experience little or no postoperative pain but grogginess, irritability, or nausea from the anesthesia can occur temporarily.
Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud.
We will plan to see you in our office several weeks after the procedure to make sure your child is doing well.
COMMON PROBLEMS WITH TONSILS AND ADENOIDS
Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.
The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing, swallowing, and sleep problems.
Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.
WHAT CAN GRAND RAPIDS ENT DO?
Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children.
Chronic infection can affect other areas such as the Eustachian tube (the passage between the back of the nose and the inside of the ear). This can lead to frequent ear infections and potential hearing loss. Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
PREPARING FOR SURGERY
- Talk to your child about his/her feelings and provide strong reassurance and support. The procedure will make him / her healthier but will cause a sore throat at first.
- Be with your child as much as possible before and after the surgery.
- Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward.
- If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.
- For at least two weeks before any surgery, don’t allow your child to take any medicines that contain aspirin (Children should never be given aspirin because of the risk of developing Reye’s syndrome). If your child is to have surgery, please call Grand Rapids ENT before giving any over-the-counter medicines or herbal products.
- If your child or family has had any problems with anesthesia, tell your GRENT doctor. If the child is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the doctor must be informed.
- A blood test and possibly a urine test may be required prior to surgery.
- After midnight prior to the surgery, nothing may be taken by mouth (including chewing gum, mouthwashes, throat lozenges, toothpaste, water.) Anything in the stomach may be vomited when anesthesia is induced. This is dangerous.
- When your child arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with you to review medical history. Your child will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.
- After the operation, your child will be taken to the recovery area. Recovery room staff will observe them until discharged. Every patient is unique, and recovery time will vary.
There are several postoperative symptoms that may arise. These include, but are not limited to, swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.