Pediatric Ear Infections & Ear Tubes

Ear Tube Surgery
A microscope is used to visualize the ear drum.  A small incision is made in the ear drum and any fluid or pus is suctioned out.  A tube shaped is inserted in the ear drum. The tube keeps the ear drum open and allows air to get into the middle ear. Ear drops will be prescribed to help wash out any blood or fluid from the ear canal.

Reasons for plugged Eustachian tubes Certain conditions like allergies, swollen adenoids or sinus infections can make the Eustachian tube swell and prevent the middle ears from draining. When this happens, fluid builds up in the middle ear.   Four top causes of recurrent ear infections second hand smoke exposure day care exposure reflux allergies

Two types of problems caused by ear infections

• The first is that of acute otitis media, a typical ear infection associated with pain, fever and irritability. 
• The second, and sometimes harder to diagnose, is serous otitis media or an accumulation of fluid underneath the ear drum in the middle ear. 

How children respond to ear infections parents need to be aware of:

• Older children will complain that their ear is plugged up, but usually not painful. 
• Younger children will often not complain at all. This is a problem because the fluid causes a hearing loss and the hearing loss frequently goes undiagnosed because the child is not complaining.

Medical Treatment for ear infections

Antibiotics - The medical treatment of ear infections primarily involves the use of antibiotics.  The types of antibiotics chosen and the length of treatment typically depends on the number of infections that the child has had, the age of the child and any medication allergies.  Treatments for allergies or reflux may decrease the rate of infection.  

PE Tubes - The indications for putting in Pressure Equalization tubes when medical treatment has failed depends on many factors including: the number of infections, the severity of infections, the difficulty with which each infection clears, whether there have been complications from any infections, hearing evaluation, etc.

Ear Tube Surgical Treatment & Surgery Overview

• Outpatient surgery. 
• General anesthesia with a mask, No IV or breathing tube placement.
• The surgery takes 5-10 minutes. 

Recovery
After a short time in the recovery room, anywhere from 15 minutes to 1-2 hours, your child is can go home.  At home, your child may be a little fussy later that day but a dose of Tylenol usually takes care of any discomfort. Be careful if your child likes to climb up on things, because he/she can be a little uncoordinated after surgery for a day or so.  Ear plugs will need to be worn while bathing or swimming for the first month. After one month, if no drainage is present, you can bathe without plugs, but any community pools, lakes, rivers, etc … will require ear plugs.  

Complications
9 out of 10 times the tubes will stay in for 6-12 months and fall out on their own and your child will have no or considerably fewer infections while the tubes are in.  However, complications are possible: 

• The tube can be pushed into the middle ear during surgery (very rare).
• The tubes can become occluded with wax, blood or drainage and need to be replaced. This usually occurs within a couple of weeks of surgery and requires another operation to replace the plugged tube (rare).
• The tubes can fall out and leave a hole in the ear drum that would have to be repaired with another operation (rare).
• The most common problem is continued infections after the tubes are inserted. This can occur 10% of the time and requires trips to my office to have the ears examined and medications prescribed. Usually this can be controlled with medications, but in rare instances, the drainage persists for as long as the tubes are in and can only be controlled by removing the tubes. 

Outcome
The majority of patients will only need one set of tubes. Some require 2 or more sets. This is because the age at which each child is going to outgrow their ear problems varies. If your child’s tubes fall out before the time that he/she has outgrown the problem, another set of tubes may be required. The tubes remove any trapped fluid and buy time until your child outgrows any Eustachian tube dysfunction.

Links
Post Operative Instructions - Click to download post operative instructions after PE tube insertion.