Middle Ear Infections and Ear Tube Surgery

Why Surgery?

Many kids get middle ear infections (known as otitis media, or OM), usually when they’re between 6 months and 2 years old.

Some kids are particularly likely to get them because of environmental and lifestyle factors (like attendance at a group childcare, secondhand tobacco smoke exposure, and taking a bottle to bed).

Although these infections are fairly easy to treat, a child who has multiple ear infections that do not get better easily or has signs of hearing loss or speech delay may be a candidate for ear tube surgery.

During this surgery, small tubes are placed in the eardrums to ventilate the area behind the eardrum and keep the pressure equalized to atmospheric pressure in the middle ear.

About Otitis Media

The middle ear is an air-filled cavity located behind the eardrum. When sound enters the ear, it makes the eardrum vibrate, which in turn makes tiny bones in the middle ear vibrate. This transmits sound signals to the inner ear, where nerves relay the signals to the brain.

A small passage leading from the middle ear to the back of the nose — called the eustachian tube — equalizes the air pressure between the middle ear and the outside world. (When your ears pop while yawning or swallowing, the eustachian tubes are adjusting the air pressure in the middle ears.)

Infection

Bacteria or viruses can enter the middle ear through the eustachian tube and cause an infection — this often happens when a child has had a cold or other respiratory infection. When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is caused by bacteria.

Pressure from this buildup pushes on the eardrum and causes pain, and because the eardrum cannot vibrate, the child may have a temporary decrease in hearing.

With treatment, a bacterial infection can be quickly cleared up. In most kids, the fluid will go away over time and normal hearing will return. Some research, though, suggests that long periods of hearing loss in young children can lead to delays in speech development and learning.

Symptoms and Diagnosis

Symptoms of otitis media include:

• pulling or rubbing the ears because of ear pain
• fever
• fussiness or irritability
• fluid leaking from the ear
• changes in appetite or sleeping patterns
• trouble hearing

Call your doctor if you think your child has an ear infection. He or she will perform a physical exam and look at your child’s eardrums. If a bacterial infection looks likely (often based on whether there is pus behind the eardrum), the doctor might decide to wait and see if the immune system will clear the infection without the use of antibiotics. If fever and pain last for more than 48 hours, then antibiotics may be prescribed. This is important to know since unnecessary use of antibiotics can lead to resistant bacteria.

In some cases, the doctor will insert a needle through the eardrum to remove a sample of the pus from the middle ear for a laboratory test. Called a tympanocentesis, this procedure can help the doctor decide which antibiotic to use.

Treatment

Although ear tube surgery is a fairly common procedure, surgery is not the first choice of treatment for otitis media. Antibiotics are often used to treat bacterial ear infections, but many ear infections are viral and cannot be treated with antibiotics. These infections need to get better on their own, and only time can help them heal.

But if your child has frequent ear infections that don’t clear up easily or a hearing loss or speech delay, the doctor may suggest surgery to drain fluid from the middle ear and insert a ventilation tube.

Because most kids have had infections in both ears, surgery is often done in both; this is called a bilateral myringotomy, or BMT. A tiny tube, called a pressure equalization (PE) or tympanostomy tube, is inserted into the eardrum to ventilate and equalize pressure in the middle ear. This will help to prevent future infections and the build-up of fluid, and will help normalize hearing.

The presence of the tiny hole in the eardrum from the tube doesn’t hurt hearing (in fact, kids with a speech or language delay from hearing loss often will have an improvement in their hearing). Depending on the type used, the tube remains in place for about 6 months to 18 months or longer.

Tympanostomy Tube Surgery

If your child is old enough to understand what surgery is, talk about what happens during ear tube surgery:

• Because your child will receive general anesthesia, the surgery will be done in a hospital so that an anesthesiologist can monitor your child. The procedure takes about 10 to 15 minutes.
• The surgeon will make a small hole in the eardrum and remove fluid from the middle ear using suction. Because the surgeon can reach the eardrum through the ear canal, there is no visible incision or stitches.
• The surgeon will finish by inserting a small metal or plastic tube into the hole in the eardrum.

Afterward, your child will wake up in the recovery area. In most cases, the total time spent in the hospital is a few hours. Very young children or those with significant medical problems may stay longer.

After Surgery

A tympanostomy tube helps prevent recurring ear infections by allowing air into the middle ear. Other substances, including water, may sometimes enter through the tube, but this is rarely a problem. Your surgeon might recommend earplugs for regular bathing or swimming.

In most cases, surgery to remove a tympanostomy tube isn’t necessary. The tube usually falls out on its own, pushed out as the eardrum heals. A tube generally stays in the ear anywhere from 6 months to 18 months, depending on the type of tube used.

If the tube remains in the eardrum beyond 2 to 3 years, however, it probably will be removed surgically to prevent a perforation in the eardrum or accumulation of debris around the tube.

While effective in reducing chronic ear infections, ear tubes are not always a permanent cure for otitis media. Up to 25% of kids who need ear tubes before the age of 2 may need them again.