Pressure-Equalizing Tubes In Repetitive Middle Ear Infections

Continuing our video series, Dr. Jerome Hester explains “Pressure-Equalizing Tubes In Repetitive Middle Ear Infections.”

Children have increased number of middle ear infections for a variety of reasons. The main reason is that the eustachian tube, which is the small tube that goes from behind the nose to behind the eardrum and ventilates that area, is immature in children, and over time reaches its mature state. But in the meantime, between that issue and various other exposure issues, children do have more ear infections. Most of the times, these can be managed quite easily. However, it should not be discounted the amount of discomfort, feeling of being unwell, that the children go through because of these infections. It is significant for them.

Most of these infections do end up being treated with antibiotics, although certainly there has been a significant discussion regarding the fact that many of these infections may be viral and therefore antibiotics are not used. Despite that, most infections do receive antibiotics, and so a child may receive numerous courses of antibiotics over a year or two years’ time, which carries a risk itself.

On top of that, the other concerns are related to the fact that fluid that may remain behind the eardrum either during the infection or even for months afterwards and this decreases hearing. Although it will resolve, in those young individuals who are developing speech, things like pronunciation can be retarded at this time and they do not progress as rapidly as they might otherwise.

Finally, although it is very uncommon with those individuals who do have access to medical care, there is a risk that these recurring infections can become more serious and even penetrate into the bone surrounding the area and therefore, demonstrate a more impactful infection and may in fact require aggressive surgical management.

Overall, if a child has repetitive infections, consideration of the placement of pressure equalizing tubes should be made. The idea behind the tube is that a temporary ventilation airway between the outside world and behind the eardrum can be established until the child’s eustachian tube does mature. Unfortunately at this point, there is no good way to estimate when that tube may mature, so therefore, sometimes with the placement of tubes, the need for the tube may require six months, 12 months, or even longer.

The tube is placed generally under anesthesia. A small incision is made in the eardrum. Any infection or fluid that is present at that time is removed, restoring normal hearing almost immediately, and a small tube that may look something like a spool of thread with a ventilation port down the center and wider flanges on the end to hold it in place are placed. By most experienced otolaryngologists, this a process that takes less than minutes, and the patient is able to go back to normal activities almost immediately. The long term success of these tubes is very high. A small portion of individuals will have some issues with occasional drainage out of the ears. That is usually easily managed by the otolaryngologist. And as I mentioned earlier, sometimes the tubes, which typically last six to 12 months, need to be replaced due to the fact that the issue continues for longer than that period of time. However, during that time, the patient generally is asymptomatic and does not have recurring ear infections. Hearing is back to normal and the patient can avoid ongoing antibiotic usage.

In most cases, the need for water protection after the placement of tubes is not necessary. Certainly, the individual may not be able to submerge their head deeply under water, but routine issues such as swimming on the surface and even showering or bathing can be entertained without any kind of ear protection. Therefore, the child is really able to lead a fairly normal, active life with the absence of these infections.