Chadwick N. Ahn, M.D.
Ronald Shashy, M.D.
MYRINGOTOMY AND TUBE PLACEMENT
a.k.a. “Ear Tubes”
Why are ear tubes necessary in some people?
The placement of tubes in children and adults is generally done for the following reasons:
1) Recurrent Infections: Some people are prone to getting multiple ear infections,
oftentimes with very little time between infections. We occasionally place
these patients on antibiotics in “prophylactic” dosages to try to prevent
additional infections. Tubes are placed in these patients if the pattern of
recurrent infection continues despite medications.
2) Persistent middle ear fluid and conductive hearing loss: Fluid in the middle
ear that persists beyond several months, particularly when associated with a
significant conductive hearing loss, is an indication for the placement of tubes.
Tube placement in these patients removes the fluid, prevents its
reaccumulation, and improves hearing.
3) Negative middle ear pressure (a.k.a. “retractions”): Negative pressure can
develop in the space behind the eardrum as a result of eustachian tube
dysfunction. Normally this tube connects the ear to the back of the nose and
assists with keeping the middle ear filled with air at normal pressure. If the
eustachian tube is functioning abnormally, the ear drum will assume an
abnormal position (retraction) that can lead to long-term problems. Tubes are
placed in these patients to permit normal pressure and the appropriate amount
of air to enter the ear, allow the eardrum to return to a more natural position,
and to prevent further long-term complications.
4) Speech delay associated with hearing loss: One of the more common causes of
speech delay in children is hearing loss, and this is frequently associated with
chronic, recurrent ear infections.
How is the procedure performed?
Bilateral myringotomy with tube placement (“BMT”) is an outpatient procedure that
takes very little time to perform. The procedure is performed under a light level of general
anesthesia delivered in gas form through a mask. IV placement and additional forms of sedation
are generally not needed during these surgeries. For patients who are anxious, the
anesthesiologist will sometimes administer an oral medication in the pre-op area that makes the
process less stressful. The procedure is performed with the assistance of an operating
microscope, and a small incision is made in the eardrum. Any fluid encountered is removed by
suction and a small tube is placed through the incision. I then place antibiotic ear drops through
the tube, a cotton ball is applied to the outer ear, and the patient is awakened and taken to
recovery.
What happens after surgery?
You will be able to take your relative home after a very brief period of observation in the
recovery room. Patients experience very little, if any, discomfort following this procedure. Most
patients are up and about that same day like nothing happened. It is very common for a child to
take a longer nap than usual once they get home. It is perfectly reasonable to give Tylenol or
Motrin after the procedure if there is any discomfort or low-grade fever. Before you leave the
hospital, you will be given a bottle of eardrops to use as follows: 3 drops to be placed in each ear
3 times a day for 3 days. If you see any bleeding after the procedure, I generally ask that the
drops be applied for one week instead of 3 days. If the drops are irritating, try rubbing/holding
the bottle in your hand for 2-3 minutes before application – this generally warms the drops and
makes them more tolerable. You may notice some drainage from the ears that lasts for a few
days following the surgery – this is very common. If this procedure is being performed in your
child, and he/she still requires a bottle, please bring one to the hospital. Patients are free to
resume normal activities as soon as they have completely recovered from the anesthesia. There
is little they can do to injure or harm the tubes. I typically see patients back in three weeks in the
office and repeat the hearing test. If everything is going well and the hearing is ok, I will then
generally see patients back every 4-6 months to make sure the tubes are functioning properly.
Sounds may be louder for the patient if a significant amount of fluid was evacuated.
Most patients will acclimate (get used to) the new sound levels over the next 2-3 days following
surgery.
What are the more frequent complications associated with this procedure?
Fortunately, “BMT” is a very straightforward surgery with a very low incidence of
complications. The anesthetic risks in otherwise healthy patients is extremely low. The
anesthesiologist will fully discuss this aspect of the surgery with you on the morning of the
operation. Approximately 15% of patients will experience drainage from their tubes while they
are in place. This may occur as a result of a cold/upper respiratory illness, water contamination
of the ear, or from an actual ear infection. Ear infections may still occur after tubes are placed,
but fortunately this is unusual and most resolve very rapidly with simple treatment. Generally,
tubes are spontaneously extruded from the eardrum within the first 12-18 months after surgery.
Rarely, a hole (perforation) may persist where the tube was placed. This occurs about 1% of the
time. Most of the holes close on their own, but a few may require surgical closure. Conversely,
if tubes stay in place for too long, the risk of a perforation increases. As a general rule, I like to
remove tubes that have been in place for longer than 3 years – this is patient specific and a
decision that I reach jointly with the patient/family. It is extremely rare for ear tubes to cause
hearing loss, but it’s a point that you should consider. I would estimate the risk of hearing loss
from ear tube placement to be less than 0.1%. Scarring of the eardrum, also known as
tympanosclerosis, can occur once the tubes fall out. This scarring rarely causes a problem.
It is very common for the patient to run a low-grade fever for the first 24 hours following
surgery. Tylenol or Motrin should be given if the temperature approaches 101 degrees. It is also
very common for some nausea or vomiting to occur after surgery – some patients have this
response to anesthetic gases. Starting with clear liquids for the diet will help if nausea and
vomiting are encountered. If this persists for more than 24 hours, please give me a call to
discuss. And remember, if bleeding from the ears occurs (usually occurs when you administer
the ear drops), use the drops for one week instead of three days. Don’t worry, the bleeding will
be limited and is rarely a problem.
Water precautions and swimming
As long as the water is treated (such as bath water or pool water), I typically have no
restrictions regarding water exposure for the ears. I will ask that you keep the ears dry for the
first three weeks following surgery. This can be accomplished by placing a small cotton ball in
each ear during baths/showers (helpful hint: you can use a very small amount of Vaseline on the
cotton ball to make it stick to the ear). If the tubes look healthy at the initial post-op visit, I will
then clear the patient for water exposure. Swimming is allowed, but I ask that if your relative is
going to be swimming underwater, please keep him/her under constant surveillance. Children
who are cooperative enough to wear earplugs are encouraged to do so – these can typically be
purchased at most pharmacies and sporting goods stores. Our audiologist is also able to make a
custom-fitting mold/plug if you want a perfect fit. The custom molds are usually more
comfortable than the ones purchased in retail stores. If drainage occurs after water exposure,
antibiotic ear drops are usually given.
Alternative forms of treatment
By the time most patients are referred to me for consideration regarding tube placement,
the pediatrician or family physician will have likely exhausted most, if not all, nonsurgical
options. Medications (usually antibiotics) and control of any contributing factors (such as
allergies) are still the mainstays of treatment. If uninfected fluid is behind the eardrum (this is
called a sterile effusion), a period of observation coupled with decongestants is usually the best
course. There has been a significant amount of interest lately in the development of resistant
bacteria and the overuse of antibiotics. Antibiotics still play a very important role in the
treatment of chronic ear disease, but we may see a tendency towards offering surgery sooner in
some patients to avoid repeated exposure to antibiotics. This issue is being intensely
investigated by researchers in the ENT profession. I would caution any patient or family about
“natural” remedies – i.e. herbal medicine, chiropractic manipulation, acupuncture, etc. While I
believe that these alternative treatments serve a role in some illnesses, I am unaware of any wellcontrolled, scientifically conducted studies that show true benefit in chronic ear disease. I am
always looking for ways to improve the care I provide for my patients, and I would welcome the
opportunity to review any information you might have on alternative forms of treatment.
What if I have other questions not addresses in this handout?
This handout is not intended to answer all questions you might have about the placement
of tubes. We encourage families to ask us questions about anything you do not understand or
that has not been made clear to you. This handout is also not intended to replace the advice of
the surgeon. Each patient’s condition and needs are truly unique and may require deviation from
what is outlines above. Please call me anytime if you need more information or have questions
about the care of your child/relative.
Sincerely,
Chadwick N. Ahn, M.D.
Ronald Shashy, M.D.