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Ear Tubes (Myringotomy with tube insertion) Why
are so many children having tubes placed in their ears? Why
does my second child have ear infections when my first did not? How
do the tubes prevent infection? Do
the tubes have to be removed? Can
my child swim when he has ear tubes? What
are the risks of ear tubes? Why
are so many children having tubes placed in their ears? Over
the past 30 years, ear tube placement has become an accepted procedure for
the treatment of ear disease. In fact, ear tube placement is the most
commonly performed surgical procedure in children. Ear tube surgery should
be considered only after medical therapy has failed. The indications for
surgery can be broken down into 3 major categories:
1) Recurrent ear infections,
2)
Chronic ear fluid, and
3) Complications of ear infections. Recurrent
ear infections that have not been controlled with numerous antibiotics are
a very common reason for ear tube placement.
These children may have failed an attempt to prevent the ear
infections with a trial of low dose antibiotic maintenance as well. Chronic
ear fluid which has not drained for 3 or more months is the most common
reason ear tubes are for language development between birth and 5 years of
age, it is important that children in this age range have normal hearing.
Many studies have shown that continuous hearing loss due to ear infections
may result in delays in language development and intelligence. When the
hearing loss occurs in a school-aged child, the child may have difficulty
paying attention and may be labeled behavioral problems. When
an ear infection spreads from the middle ear to the surrounding bone or
brain tissue, an emergency complication has developed. Ear tubes in these
cases are usually combined with other surgical procedures. Long standing
ear fluid is known to cause a continuum of diseases to the eardrum.
If the disease is not reversed in the early stages by ear tube
placement, more severe changes can develop. Why
does my second child have ear infections when my first did not? Many
factors are weighed to determine if tubes should be inserted. The main
factors which favor surgery include children under the age of 2 years,
involvement of both ears, being in a group daycare setting, frequent
exposures to cigarette smoke, structural changes to the eardrum, poor
tolerance to antibiotics, and multiple antibiotics drug allergies. How
do the tubes prevent infection? There
is nothing magical or sophisticated about the way ear tubes work. The ear
tube is simply a tiny hollow tube, which is placed in the eardrum. The
tube works as a temporary Eustachian tube by allowing air to enter the
middle ear, which helps swollen tissues to return to normal, and allowing
hearing to return to normal. The tube also allows for future ear
infections to drain and prevent collections of ear fluid. Ear
tubes are a temporary way to treat ear infections. After the ear tube is
placed, your child's body recognizes it as a foreign material and begins
the process to remove the tubes. The standard ear tube lasts 9-15 months.
During this time period, your child has the opportunity for physical
growth and development of his Eustachian tube so that it can be more
effective at resolving ear infections. Also during the time the ear tubes
are in place, new ear infections will drain and will markedly reduce the
fever and pain associated with infections. Topical eardrops can be used to
treat the ear drainage and prevent the need for oral antibiotics. Do
the tubes have to be removed? Some
children reject their ear tubes in less than six months, but frequently
their ears were healthy long enough to no longer have chronic ear
infections. If necessary, the tubes will be reinserted. Other children
have ear tubes that remain in place for several years and ultimately need
surgery to remove the tube and close the hole in the eardrum. The
procedure is performed as an outpatient surgery under general anesthesia.
The procedure takes approximately 10 minutes using a mask for anesthesia
and no IV. No preop bloodwork is needed. However, some children with
underlying medical problems may require and IV and breathing tube to be
used for optimal safety. Long-term
tubes are designed to last 3-5 years, not permanently. These tubes are
usually reserved for children with a history of ear tube placement in the
past but still have ongoing problems with their Eustachian tubes or are in
high-risk categories, such as children with a cleft palate or with Down
syndrome. These long-term tubes have a high chance of eventually coming
out and leaving a large hole in the eardrum, which may require surgery to
close. Can
my child swim when he has ear tubes? The
issue of swimming with ear tubes is controversial. Just about all doctors
will allow your child to swim after he has had ear tubes placed. However,
most doctors will require ear plugs and/or swim headbands to help prevent
water from entering the ear and causing an ear infection. Some doctors do
not recommend any ear protection at all for bathing or swimming. There are
studies to support both opinions; however, an ounce of prevention may lead
to a pound of cure. If you do not use ear plugs and your child develops an
ear infection, the drainage may lead to early extrusion of the tube, may
dry up and block the opening of the tube making it nonfunctional, or
require several trips to your doctor's office to suction out the drainage. What
are the risks of ear tubes? The
risks of your child undergoing ear tube placement are related to
anesthesia and those directly related to surgery. Before surgery, you
should meet with the anesthesiologist who will be putting your child to
sleep. You will then have an in-depth discussion about the risks of
anesthesia. The major risks due to the ear tube surgery include: eardrum scarring, early rejection of the tube, failure of the ear tube to fall out leading to the need to remove the tube in an additional surgery, chronic hole in the eardrum after the tube falls out (1-2% risk with short-term tube, 20% risk with the long-term tubes), polyp formation around the tube, and ear tube blockage with dried mucous or blood. The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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Copyright © 2008 Atlanta Children's ENT. | |
