Many years ago, it was discovered that recurrent ear infections could be traced to lack of air getting into the middle ear. Since the eardrum moves forward and backward when sound waves hit it, the air in the middle chamber must also move in and out. The body's natural conduit for this air is the eustachian tube. This connects the middle ear chamber with the back of the nasal passage and, thus, to the outside atmosphere.
If this tube is plugged, the air is trapped in the middle ear. This alters hearing only slightly, if at all, but if the eustachian tube remains closed, the air in the middle ear is absorbed in the bloodstream and a "vacuum" occurs. If this persists for hours, the body secretes fluid to fill the space now empty of air. Eventually, bacteria multiply and an ear infection is born.
One of the main causes of a middle ear infection is such blockage of the eustachian tube. The tube can be blocked by adenoid tissue obstructing the eustachian tube opening in the back of the nasal chamber; thick mucus; the tube's own lining tissue, which has become swollen due to viral cold or allergy; an abnormality in the course or diameter of the tube itself.
Whatever the cause, the process previously described is set into motion. One can combat recurrent ear infections by controlling the cause.
If adenoids are large and obstructive, remove them. (The tonsils have no essential relation to provoking ear infections and their removal is of little value for this problem.) After colds, prevent the formation of copious, thick mucus by timely intervention with antibiotics. Control allergy problems that lead to the production of mucus and tissue swelling. If there is an abnormal eustachian tube, create an artificial entrance for air into the middle ear. This is where "ear tubes" come into the picture.
These small plastic tubes are inserted through the eardrum and are called PE tubes, ear tubes or ventilating tubes because that best describes their function.
Contrary to popular belief, they are not drainage tubes to let fluid out of the ear. They prevent vacuum formation that leads to a fluid-filled middle ear. As soon as the ventilating tube is inserted, hearing returns to normal and stays that way as long as the tube does not plug. (The moment the ventilating tube plugs, the vacuum-and-fluid process starts, just as if the eustachian tube were blocked.)
These ventilating tubes will usually remain in for nine to eighteen months before they fall out on their own. If the underlying ear problem was not solved, it recurs when the ventilating tube is gone. Thus, the tube is not a cure, but it protects the ears while the basic condition is corrected through an adenoidectomy, an allergy control program, or simply waiting for the eustachian tube to grow in diameter and render it less easy to plug.
Ventilating tubes let in not only air, but water. Thus, submerging them under water, without ear plugs approved by the surgeon, is dangerous.
I feel ventilating tubes should be installed only after other control measure have failed. Patients who have recurrent ear infections may be safely spared ventilation-tube surgery by the use of a prophylactic antibiotic, like Gantrisin (a sulfa drug). It is given twice a day. It presumably prevents bacteria from growing in the fluid that might transiently collect in the middle ear.
Patients who have continuous eustachian tube blockage do not respond well to such therapy. However, as many as 50 percent of children with recurrent ear infections may do well on antibiotics and thus never need ventilating tubes.
Whether you use VTs or continuous antibiotic therapy, close follow-up is essential. Fluid may collect, or a tube may plug without dramatic symptoms. In addition to carefully inspecting the eardrum, it may be helpful to use a tympanogram, which measures the ability of the eardrum to move.
Installation of ventilating tubes can produce infrequent complications, such as persistent perforated eardrums, or damaged middle-ear "hearing bones". In my own experience, and that of others who have published articles in medical journals, the chances of complications are far outweighed by the benefits of preserving normal hearing..
In general, as parents you should have answers to the following questions before you agree to the insertion of ventilating tubes: What is the most likely basic cause of the recurrent ear infections; are we trying to do something about this basic cause so that when the tubes come out, we won't have to put them back in; is our child a candidate for a trial of continuous antibiotic therapy before tubes are placed.
When these questions are answered, you will find it easy to decide whether your child should have ventilation-tube surgery, and you will be satisfied you have fulfilled your responsibility as a parent.