Jane M. Emanuel, M.D.
Boys Town Ear, Nose & Throat Institute
Ear tubes have a couple of different names. One of the formal names is pressure equalizing tubes or ventilation tubes. Basically, that's what they are. They are little tiny plastic tubes, put in the eardrum to equalize the pressure and let air in behind the eardrum. So, that the fluid or recurrent infection troubles you're having are less likely to happen.
When is placing tubes necessary?
There are some certain guidelines that we look at but a lot of times it's a combination of a number of factors. The major reason we'll put ear tubes in is consistent fluid behind the eardrum, which is usually after an ear infection in kids. It's usually after the fluid has been there a period of months, often times, a period of three months if they're not having any other complicated things.
It's usually not just simply fluid. There's usually some combination of repeated infections during that time frame. We also look at how much this is impacting the hearing, if the child already has speech delay or some other issues, that may change the time frame.
How can placing ear tubes help a child?
If you have a fluid behind your eardrums, you'll have a mild hearing loss. It's about a 25 decibel hearing loss. You can still hear, and parents will come in and say, I know they can hear because they will respond, but it still does give you a hearing loss.
Once you put the tube in, you let air in, fluid goes away and everything goes back to normal. Then you also have better plumbing so you're less likely to get acute ear infections as well.
Some kids with ear fluid it really affects their balance, other kids it does not, but it certainly could make a difference.
It certainly makes a difference in speech development especially in that one-year old, two-year old. If they're walking around with a hearing loss for a month they aren't going to develop speech as well, so there's certainly a benefit from that. We use tubes aggressively in our kids who have speech delay.
How are tubes placed?
Putting tubes in is going to require a general anesthetic, a short out-patient anesthetic. They are asleep for about five or eight minutes with that.
When we're doing that we look through the microscope, look at the eardrum, and make a tiny, little millimeter cut in the eardrum. We suction our fluid from behind the eardrum and then we slip the ventilation tube in that opening.
Basically, the tube is to keep the hole open. If we just made the cut and sucked out the fluid, that little cut will heal within a few days. The tube keeps the hole open so it keeps air going back and forth and makes the plumbing of the ear better and they have less troubles.
It's very routine for us. It's never routine for you when it's your child having the procedure but it's something we do multiple times per week. You come in and go home in a period of a couple of hours and generally, back to daycare, back to normal activities tomorrow.
How long do the tubes stay in?
Tubes do require a little bit of after care. We usually see kids back a couple of weeks afterwards and make sure everything looks good. Then we do want to check the tubes every six months either with an ENT or your primary care physician to make sure they come out as well.
Tubes grow their way out. It's not like they all of a sudden pop out. If you see one fall out of your child's ear, it's actually been in their ear canal for awhile.
They stay in, varying by the type of tube we put in, usually about a year. A year is average, some will come out six or eight months, once in awhile one will plug up, some stay longer.
A few of them don't come out which is why we check kids very six months. If they don't come out in the two or three-year time frame from when we put them in, we are going to start talking about a small surgery to take them out as well.