During the first two installments of this series, "The Truth About Ear Infections," we looked into the diagnosis and medical management of acute otitis media (ear infections.) The following discussion will hope to answer the following questions: What are ear tubes? When might my child need ear tubes? Is a surgery required and if so, who will be doing it?
Ear tubes go by several different names, PE tubes (pressure equalization), myringotomy tubes, and tympanostomy tubes...but they all basically refer to the exact same thing. These are small grommet shaped tubes that are inserted in the tympanic membrane (ear drum) by a physician who specializes in problems of the ears, nose, and throat. This procedure has been around since the 1950s and is routinely performed on children with chronic fluid in the middle ear or a history of multiple ear infections
The current recommendations for evaluation and possible placement of ear tubes is a diagnosis of 3 episodes of ear infecitons within a 6 month period or 4 episodes within a 1 year period. Other indications include ear infections that have failed multiple rounds of antibiotic therapy, as well as a history of chronic middle ear effusion (fluid behind the ear drum) that is affecting the child's hearing and subsequent speech and development.
As mentioned above, otitis media is medical lingo for fluid in the part of the ear that is behind the ear drum. When the fluid is infected with pus we call it an acute otitis media or ear infection. If there is no infection, only clear fluid, then we call it an otitis media with effusion. Normally, the eustation tubes drain fluid from that area, keeping that area free of fluid and filled with air. Blockage and occlusion of the eustation tubes occurs frequently in young children predisposing them to collections of fluid and bacteria in the middle ear chamber. It is important that this area remain air filled because our hearing is very much linked to the ability of the ear drum to vibrate back and forth in response to sound waves. This is the start of the cascade of events that allows us to hear. You can easily imagine that if the middle ear is filled with fluid and the ear drum cannot vibrate, one's hearing could certainly be muffled. This is particularly important in young children who are learning how to make sounds and discern how speech should sound.
The main purpose of ear tubes is to allow fluid, whether that is clear fluid or infected pus, to be able to drain out of the middle ear. As a general rule, if fluid has been in the ear for greater than 4 months or the parents have concerns about their child's hearing, a hearing test should be performed and a discussion about tube placement should take place.
Hopefully, this is a talk that you and your physician will never have to have. However, if this topic does come up in the future, we hope you will be able to use what you learned from this article as a foundation for your disscussion.