Myringotomy Tube Placement

Most children experience at least one ear infection.  It is one of the most expected health issues parents experience in the newborn or toddler children.   Most ear infections either resolve on their own or are well-treated by antibiotics. Occasionally, they do not resolve or leave a persistent fluid behind.  If there is persistent fluid, this can lead to a chronic problem, such as hearing loss, speech problems, and recurrent pain, retraction of the eardrum or a perforation and drainage. In these cases, insertion of an ear tube or myringotomy tube by an otolaryngologist (ear, nose, and throat specialist) may be considered.

What are myringotomy tubes?

Ear tubes are tiny grommets placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes or ventilation tubes.

These tubes can be made out of various materials 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 by an otolaryngologist may be necessary.

When are myringotomy tubes needed?

Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or Eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes as in flying and scuba diving).

Each year, more than 500,000 ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age for ear tube insertion is one to three years old. Inserting ear tubes may:

  1. • Reduce the risk of future ear infection
  2. • Restore hearing loss caused by middle ear fluid
  3. • Improve speech problems and balance problems
  4. • Improve behavior and sleep problems caused by chronic ear infections.

How is a myringotomy tube placed?

Myringotomy refers to an incision in the ear drum (tympanic membrane). This is most often done under a microscope with a small scalpel. 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).

A general anesthetic is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be prescribed for a few days. The procedure usually lasts less than 10 minutes and the patient wakes up.

Sometimes the otolaryngologist will recommend removal of the adenoid tissue at the time the ear tubes are placed. This is often considered when a second or third tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infections and the need for repeat surgery.

What is recovery like?

After surgery, the patient is monitored in the recovery room and will usually go home within an hour or two if no complications occur. Patients usually experience little or no postoperative pain, but tiredness, irritability, and nausea from the anesthesia can occur temporarily.  Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery.

The otolaryngologist will provide specific postoperative instructions, including when to seek immediate attention and to set follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days. An audiogram should be performed after surgery, if hearing loss is present before the tubes are placed.  This test will make sure that hearing has improved with the surgery.

To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary. Parents should consult with the treating physician about ear protection after surgery.

What are the possible complications?

Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:

  1. Perforation.  This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a surgical procedure called a tympanoplasty or myringoplasty.
  2. Scarring.  Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing.
  3. Infection.  Ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss, and are easier to treat, often only with ear drops. Sometimes an oral antibiotic is still needed.
  4. Ear tubes come out too early or stay in too long.  If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by an otolaryngologist.
  5. Hearing loss.  Temporarily after surgery there is hearing loss due to the tube and its weight which leads to less vibration of the ear drum.  This recovers after the tube falls out.  However, occasionally the trauma of placing the tube can lead to hearing loss.  If there was hearing loss prior to placement of the tube due to fluid in the ears, the hearing is actually better after placement of the tubes.
  6. Tinnitus.  Often temporary, there may be increased ringing in the ears after placement of the tube.  This typically resolves after the tube falls out.  If hearing improves after placement of the tube, most tinnitus will improve.
  7. Otorrhea.  Drainage can occur after an opening in the ear drum is made.  This occurs in 10 percent of adults and kids.  It is treated with ear drops and typically resolves.