Definition and Frequency
A ventilation tube (ear tube) is a tiny, millimetre-sized cylinder placed in the eardrum; by ventilating the middle ear, it temporarily takes over the job of a poorly functioning Eustachian tube. Ear tube placement is one of the most frequently performed ENT surgical procedures, particularly in childhood; the main reason is that in children the Eustachian tube is shorter, runs more horizontally and becomes blocked more easily than in adults. Adults may also need tube placement because of complaints related to Eustachian tube dysfunction.
The most common reason for the procedure is fluid in the middle ear that lasts longer than three months and affects hearing (otitis media with effusion). Frequently recurring acute middle ear infections, marked inward collapse of the eardrum (retraction) and chronic Eustachian tube dysfunction in adults are other conditions for which tube placement is considered.
Symptoms and When It Is Considered
Children with fluid in the middle ear usually have no marked pain; instead, reduced hearing, wanting the television or speech louder, poor attention, balance problems or delayed speech development may be noticed. Children with frequently recurring middle ear infections have a history of repeated episodes of fever, ear pain and discharge. In adults, Eustachian tube dysfunction may present as a feeling of fullness in the ear, hearing one’s own voice differently, ear pain with pressure changes (flying, diving) and occasional fluctuations in hearing.
When these complaints last longer than three months, occur as recurrent episodes, or lead to hearing loss or delayed speech development, ventilation tube placement comes into consideration as a treatment option.
Causes and Risk Factors
Middle ear fluid and recurrent infections are largely rooted in Eustachian tube dysfunction. In children, factors that increase the risk include enlarged adenoids, attending daycare or spending time in crowded settings, exposure to cigarette smoke, frequent upper respiratory infections, anatomical differences such as cleft palate, and a family history of chronic ear problems. In adults, allergic rhinitis, chronic sinusitis, residual adenoid tissue, structural problems inside the nose and, rarely, nasopharyngeal masses can impair Eustachian tube function; in an adult with one-sided, persistent Eustachian tube dysfunction, ruling out such structural causes is particularly important.
Diagnosis
Diagnosis begins with a detailed history and examination of the ear with a microscope or endoscope. The colour and mobility of the eardrum and any fluid level are assessed. Tympanometry is an important test that objectively shows the presence of fluid in the middle ear and the mobility of the drum; a flat curve usually indicates fluid in the middle ear. Audiometry determines the degree of hearing loss; in small children, age-appropriate play-based or behavioural hearing tests can be used.
In adults, or in cases with one-sided, recurrent effusion, examination of the nasopharynx (nasopharyngoscopy) and, where needed, imaging are added to the evaluation to rule out an underlying structural cause. A similar evaluation may be carried out in children in whom enlarged adenoids are suspected.
Treatment Options
Conservative Approach
Most cases of middle ear fluid, particularly within the first three months, can resolve on their own; therefore, if the hearing loss is mild and there are no other risk factors, a period of observation is an appropriate approach. Treatment for allergic rhinitis or nasal congestion, Eustachian tube exercises and advice on avoiding upper respiratory infections may be helpful during this period. However, when the fluid persists beyond three months, the hearing loss becomes significant or recurrent infection episodes continue, the surgical option is considered.
Surgical Treatment
Ventilation tube placement is usually performed under general anaesthesia in children and mostly under local anaesthesia in adults, in an operating theatre or procedure room. Under microscope guidance, a small incision is made in the eardrum (myringotomy), the accumulated fluid is suctioned out and the tube is placed in this incision. The procedure takes a few minutes per ear and requires no external incision or stitches. Where considered necessary, particularly in children with frequently recurring infections, adenoid surgery (adenoidectomy) may be planned in the same session.
Recovery and Follow-up
After the procedure there is a clear improvement in hearing, which is usually noticed immediately. While the tube is in place, it is advised to keep soapy or dirty water out of the ear; brief contact with clean water causes no problem in most cases, but earplugs may be recommended in settings such as pools or the sea. Standard tubes are usually pushed out on their own within six to twelve months as the eardrum renews itself, and the drum most often closes without a scar.
Patients with tubes are called for check-ups at regular intervals to assess the position and function of the tube and the condition of the eardrum. Reassessment may be needed if the tube comes out early, becomes blocked again, the ear discharges, or complaints return after the tube has come out. Rarely, a small permanent hole may remain at the tube site; this may require a separate repair.
What Families and Adult Patients Should Know
One of the questions parents of children with ear tubes most often ask is when hearing will improve. In most cases, hearing improves markedly straight after the procedure as the fluid in the middle ear is drained; this contributes positively to both the child’s speech and language development and school performance. In children with a history of recurrent middle ear infections, feverish infection episodes and the resulting school absences also usually decrease markedly after tube placement.
In adult patients, a ventilation tube is preferred particularly for people who frequently engage in activities involving pressure changes, such as air travel or diving, or whose daily quality of life is markedly affected by chronic Eustachian tube dysfunction. Because the effect of the tube is not permanent, the underlying cause (for example, allergic rhinitis or a structural problem inside the nose) should be evaluated separately and treated where possible; otherwise, the likelihood of complaints returning after the tube comes out may increase. In some patients, if complaints continue after the tube has come out, long-term tube options or additional procedures aimed at the underlying cause may be considered.
Long-term Outlook After the Procedure
In the great majority of children who have ear tubes, the eardrum heals without problems after the tube comes out and middle ear function returns to normal. However, in some children complaints may recur before the Eustachian tube has finished maturing; in this case a second tube may be needed. As age increases, the anatomy of the Eustachian tube approaches its adult form, so the need for repeat tubes usually decreases. It is important for families to monitor their child’s hearing and speech development at regular intervals so that a possible recurrence is noticed early. In school-age children, teachers sharing their observations about hearing with the family can also help in assessing how well the tube is working.
Who Should Be Evaluated
Children who have had hearing loss, attention problems or recurrent infection episodes for longer than about three months should be evaluated by an ENT specialist. Falling behind expectations in speech and language development, and attention- or hearing-related observations noticed by a teacher at school, are also important signs for evaluation. In adults, people who experience recurrent ear pain and a feeling of fullness in situations involving frequent pressure changes, such as air travel, diving or working at high altitude, should also be evaluated.
Frequently Asked Questions
Is ear tube placement a painful procedure? Because the procedure is very short and performed under anaesthesia, pain is not expected; there may be mild discomfort afterwards.
Can I swim after the tube is placed? Brief contact with clean water usually causes no problem, but soapy or dirty water getting into the ear should be avoided, and earplugs used if necessary.
When does the tube come out, and does it need to be removed? Standard tubes usually come out on their own within six to twelve months; in most cases no separate removal procedure is needed.
Does every fluid build-up require a tube? No; short-lived and mild fluid build-ups often resolve on their own. A tube is recommended in long-standing, hearing-affecting or recurrent cases.
Are ear tubes also placed in adults? Yes, tube placement is also a treatment option for adults with persistent complaints due to Eustachian tube dysfunction.
For the summary:
Back to the short articleThis article is for general information purposes only; please consult your physician for diagnosis and treatment.