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Wednesday, May 11, 2011

Ear Tubes: Getting Them Put In And What to Expect Afterwards

 by JC Leahy, RN, BSN, MA
What are Ear Tubes and Why Are They Used?
Inflammation and fluid from infections in the middle ear may cause hearing loss, speech problems, balance problems, or changes in the structure of the ear drum (including scarring). 
Ear tubes are tiny tubes which are placed in the ear drum (tympanic membrane). They allow drainage of fluids and flow of air.  In medical jargon, ear tubes are called tympanostomy tubes, myringotomy tubes, or pressure equalization (PE) tubes.  All these terms refer to the same thing:  ear tubes.   Fluid drained from the middle ear is most often present because of ear infection (otitis media).  Sometimes the fluid may cause a hearing loss (otitis media with effusion). 
The concept behind ear tubes is simple: If there is fluid trapped behind the ear drum you can drain it by punching a tiny hole in the ear drum.  This is a simple concept but it has one problem:  the ear drum would heal in a matter of days, closing the drain hole.  An ear tube is used to keep the drain hole open over time. 
How much time?  Basic ear tubes stay in place for 6 to 12 months.  These are called “short term” ear tubes.  Short term ear tubes generally fall out on their own. The ear drum then heals and the hole closes.  Long term ear tubes, on the other hand, have special flanges to keep them in place over a longer period of time.  They may fall out on their own or they may need to be removed by an ear/nose/throat (ENT) doctor (otolaryngologist).  They generally should not be allowed to stay in place for more than two years.
Less common indications for ear tubes include malformation of the ear drum or Eustachian tube, Down Syndrome, cleft palate, and barotraumas from flying or scuba diving.
What to Expect When Ear Tubes Are Inserted
Short term ear tubes may be inserted in the ENT physician’s office or clinic.  Here’s the process you can expect:
  Consent -- Before ear tube insertion, the ENT physician will explain the procedure and obtain your signature on an “informed consent” form. 
Anesthesia (local)-- You will sit in the ENT exam chair.  Near the exam chair there will be surgical microscope.  The surgical microscope looks a little like an oversized desk lamp sitting on a floor stand with an articulated arm.  At the end of the articulated arm, instead of a desk lamp, there is a special microscope used for visualizing the ear drum.  Peering through this microscope, the physician will place a small quantity of phenol on your ear drum.  You may feel a slight burning sensation at first, but that will soon change to no feeling at all. This is local anesthesia to prevent pain.
Placement of the Ear Tube -- After your ear drum has been anesthetized, still using the surgical microscope for visualization, the physician will use a small instrument called a myringotomy knife to make a small hole into your ear drum.  A small, metal suction tube will be used to drain off ear fluid.  The suction may sound loud to you, since it will be right next to your ear drum.  Into the hole the ear tube will be placed.  The whole process of placing the ear tube usually takes less than 15 minutes.
What to Expect After Ear Tube Placement
Drainage -- Ear drainage is called otorrhea. Ear tubes allow fluid to drain away from behind your eardrum. Otorrhea immediately after ear tube placement is normal. This drainage may be clear or pinkish. Deal with drainage by simply wiping the outside of the ear with a tissue or soft cloth.  There may be a scant amount of blood in the drainage. Drainage more than a week after ear tube placement is abnormal but not an emergency.
Pain Control-- You may experience a little discomfort for a few days after the ear tube placement. You may use acetaminophen (Tylenol)for mild pain control. Aspirin and Ibuprofen (Advil, Motrin) should be avoided in the first couple of days after ear tube insertion because they may promote bleeding. Bleeding could clog the ear tube.  You may also experience nausea, vomiting or fatigue in the hours immediately after ear tube placement and is not abnormal.
Hearing -- If you had a conductive hearing deficit before ear tube placement, you may experience improved hearing afterward.   You may also experience clicking or popping sounds for a few weeks, and that is normal. If you had a hearing problem caused by inner ear fluids (otitis media with effusion) your ENT physician may order a hearing test after ear tube placement.
Diet--  You may resume your normal diet immediately.
Activity and Water Precautions -- You may resume your normal activities with the following water-related precautions.  You may swim in a chlorinated pool without ear protection provided that you do not submerge your head more than 18 inches under the water.  If you wish to submerge more than 18 inches, ask your ENT physician about protective ear plugs, swim cap, or Ear Bandit. A head band may help keep ear plugs in place.  Head bands are available at many sporting goods stores.   You may not swim in a natural body of water without protective ear protection because natural, un-chlorinated, outdoor water is not as clean.  Do not spray a shower head directly into your ear.  Because soapy water slides into the ear easily, do not submerge your ear into bath water without protective ear plugs.  Wash your hair without allowing water into your ear.
Air Travel-- You may fly immediately after ear tube placement.
Ear Drops --  Your ENT 
Follow-up -- Schedule a follow-up ENT physician appointment 3 or 4 weeks after placement of your ear tube.  After that, visit the ENT Clinic again every 3 or 4 months while the ear tube is in place.
Possible Complication of Ear Tube Placement 
Myringotomy and placement of PE tubes is a common and safe procedure.  However, there are several possible complications.  These include:

·         Perforation -- Usually the hole in the ear drum closes after the ear tube is removed or falls out.  Sometimes it doesn’t, especially if the ear tube remains in place for more than two years.  If the hole doesn’t close, it can be surgically patched.  This surgical procedure is called a tympanoplasty or myringoplasty.
·         Scarring -- Sometimes, ear tubes can leave a scar on the ear drum, especially after repeated ear tube insertions.  Scars can also be caused by other irritations of the ear drum, such as recurrent ear infections.  Ear drum scarring is called tympanosclerosis or myringosclerosis.  Usually, ear drum scarring causes no problems.
·         Infections -- By promoting drainage and air circulation to the middle ear, ear tubes are supposed to help eliminate ear infections.  Nevertheless, ear infections can still occur with the ear tube in place, but hopefully they are less severe than they might have been.  Ear infections may present as greenish or yellowish drainage, with or without pain.  If the infection is bacterial, ear infection is usually treated with antibiotic ear drops.  In some cases, oral antibiotics may be prescribed.
Possible Related Procedure
If you require ear tubes repeatedly, your ENT physician may recommend an adenoidectomy.  This is removal of the adenoid tissue.  Adenoid tissue is lymph tissue located behind the nose.   If an adenoidectomy is performed, it will be performed in the operating room, not the physician’s office or clinic.  A fresh ear tube will probably be placed at the same time.  In this instance, the purpose of an adenoidectomy would be to reduce the risk of recurrent ear infections.
When to Call Your Doctor
  • ·        Call your ENT doctor if you experience ear drainage more than a week after ear tube insertion, or if drainage becomes yellowish or greenish -- with or without pain.
  • ·        Call your ENT doctor if you experience a temperature of greater than 101.
  • ·        Call your ENT doctor if you experience nausea, vomiting, or fatigue for more than 3 hours after ear tube placement.
  • ·        Call your ENT doctor if you got water in your affected ear and are not using antibiotic ear drops.
  • If you think you have an emergency, go to an emergency room.

Typical ENT outpatient clinic procedure room.

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