Ear Tubes

After talking to you and examining your child, the decision has been made to place tubes in his or her ears, most likely because of fluid behind the ear drum, ear infections and/or hearing loss. These conditions usually develop because the ear has not matured yet. For good hearing, sound must travel down the ear canal and vibrate the ear drum, hearing bones and inner ear. There must be air behind the eardrum for this to happen. Air gets there through the eustachian tube which runs from behind the nose to behind the ear drum. If the eustachian tube is not working well, not enough air gets behind the ear drum, and any air that is there becomes absorbed into the tissues, creating a vacuum which pulls tissue fluid into the space behind the eardrum (the middle ear). This fluid can dampen the movement of the eardrum causing a temporary hearingloss. The fluid also can become full of bacteria causing an ear infection.

What do Ear Tubes Do?

When the above problems are persistent and fail to resolve with medication, Pressure Equalizing, or PE tubes, are usually placed in the ear drum. These tubes allow sufficient air to pass through the tube into the space behind the ear drum so a vacuum does not develop and fluid does not form there. This then lessens ear infections and reverses any hearing loss caused by the fluid. The tube will generally remain in the ear drum for 6 to 12 months or longer. Hopefully by that time the eustachian tube has matured to do the job itself; if not, problems may recur and another set of tubes may be needed. (this occurs in 30% of cases)

In general, most children with tubes do quite well, however a few problems can arise including plugging of the tube, perhaps requiring it to be replaced, failure of the tube to fall out after 2 to 3 years requiring surgical removal, drainage from the ears while the tubes are in place (1 5%) occasionally requiring tube removal, or a hole in the ear drum after the tube comes out. (1 2%) These holes are usually small and usually don’t effect the hearing but may need some kind of surgical repair at an older age.

The Day of Surgery

On the day of surgery the child should have nothing to eat after midnight but may take CLEAR liquids up to 6 hours before surgery. NOTHING AT ALL should be taken by mouth, not even water, for six hours prior to surgery. An exception to this would be any medications the doctor has instructed you to take that morning. Failure to follow these guidelines will likely result in the cancellation of surgery that day. If you have any questions about this please call the office.

You will need to arrive at the surgical facility well before the scheduled time of surgery. A day or two before surgery you will be called by the doctor’s nurse or someone from the facility with specifically what time to arrive. The surgery takes about 15 minutes. During surgery your child will be kept asleep by breathing gas given by a face mask under the supervision of an anesthesiologist. Occasionally, usually with older children, an IV will be started. The doctor will talk to you after the surgery is done. Please stay in the waiting room the whole time your child is in surgery. After surgery the child will be in the recovery room for about 30 minutes. You probably will be able to sit with your child for part of this recovery time. You will usually be allowed to leave about 30 minutes after surgery.

Once You are Home

Once home allow your child to slowly drink some clear liquids. If in a half hour he or she is doing well then slowly allow a more normal diet to be eaten if desired. If the child vomits, wait 30 minutes and try the clear liquids again. Your child may be clumsy due to the anesthesia so watch them closely and avoid situations that could lead to a fall. The following day he or she may resume normal activity. Your child may be fussy or have some mild pain, if so you may give some Tylenol (acetamenophen). Be sure to follow the label directions. You may see some bloody, clear or cloudy drainage from the ear for 3 or 4 days, but please do not let this worry you.

You may be given some ear drops at the time of surgery, if so use the drops as the doctor directs, usually 3 drops in each ear 3 times a day for 3 to 5 days. If not you will probably be given a prescription for drops at your follow up visit. Don’t be alarmed if the drops seem to cause some pain or discomfort as they do tend to sting for a brief time when first put in.

Follow up Care

As discussed above, there may be some drainage, (other than wax), from the ears on occasion. If so use the ear drops you have been given or prescribed by the doctor” usually 3 drops in the draining ear 3 times a day for about 7 days or until the drainage stops. If this problem is persistent or recurrent please call the office. You can help minimize the chance for drainage by keeping your child on a decongestant when he or she gets a cold and by keeping water out of the ears. Fitted ear plugs and swimming head bands can be purchased at the office if you desire.

Please make an appointment now to have your child’s ear checked about 3 to 4 weeks after surgery.This visit is to be sure that the tubes are in the proper position and that they are not plugged with mucous or blood. There is no charge for this first postoperative examination. Your child may have a hearing test done at that visit, (especially if they are over 2 or have speech or hearing problems); there is a charge for this test as well as any ear plugs or head bands you purchase. If all is going well, the doctor will usually check the ears every 6 to 10 months after this first check until the tubes are out and the ears are healthy. Some situations will require more frequent checking. If you are covered by an HMO or Medicaid please be sure to call for approval for any office visits. Should your child develop persistent or recurrent ear problems prior to your regular check up, or should questions arise, please call the office.