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The Informed Parent

Tympanostomy Tubes: The Five W’s

by Laura Murphy, M.D.
Published on Feb. 24, 2003

As I struggled to peer into the recesses of squirming two-year-old Katie’s ear, I saw the usually flat and grayish eardrum bulging out towards me, angry, red and apparently ready to burst. Katie screamed in fear and pain as I returned her to her exasperated mother’s arms. Although they were seasoned in the ear infection experience with four recent episodes, both looked utterly exhausted. “Is she going to need tubes?” her mother asked...

The placement of tympanostomy tubes is the most common surgical procedure performed on children. It is an appropriately common procedure for an extremely common problem: otitis media, or ear infection. A 1990 study by the CDC counted 24.5 million office visits for otitis media, and identified it as the most common diagnosis for illness made for children under 15 years. For some children, it becomes a chronic and very troublesome problem that requires surgery. The prospect of surgery is inevitably stressful for families. There are many questions that accompany a referral to the ENT specialist (Ear, Nose,Throat) for the evaluation of possible tubes. The following addresses the five “W’s”: the who, what, where, when and why of tympanostomy tubes.

Who Gets Tympanostomy Tubes?

Once a child has had several episodes of otitis media, parents often want to know at what point does this become a surgical problem. Most know of other children who have had tubes placed and wonder if their child fits the profile as well. Insertion of tubes is usually done for three main indications:

  1. Unilateral or bilateral chronic effusion: in other words, more than three months of fluid in the middle ear space. The presence of fluid is different than an acute infection, but is important in that its presence may affect hearing.
  2. Recurrent acute ear infection: may be defined as four or more episodes in six months.
  3. Two or more breakthrough episodes of acute infection while the child is on daily antibiotic prophylaxis.
  4. ** Other indications might include more rare complications of acute ear infection. The above, however, are the most common reasons for which tubes are placed.

What Are Tympanostomy Tubes?

A tympanostomy tube is a tiny synthetic tube that looks somewhat like a small spool of thread. It is inserted into the tympanic membrane (or eardrum) to create a temporary hole. This allows proper ventilation of the middle ear space. It provides a temporary solution to the child’s ear condition, in a sense buying time while we wait for the child to outgrow the underlying ear dysfunction.

Where Is The Procedure Performed?

Insertion of tympanostomy tubes is usually an outpatient procedure, performed at the hospital or surgery center.

When Is The Procedure Performed?

This can be done at any time for a child with the proper indications. However, some may prefer to do the procedure in the fall and winter months. This is because children with recurrent ear infections tend to have fewer during the summer. They may benefit more from their tubes during the winter with the onslaught of upper respiratory infections that it brings. Also, tubes are harder to care for during the summer with the need for careful water precautions. Of course, every situation is different and it’s fair to say that tubes can certainly be placed at any time of year.

Why Are Tympanostomy Tubes Placed?

Tympanostomy tubes are placed to allow better ventilation of the middle ear. The middle ear is the space between the eardrum and the inner ear, an air-containing space that also houses the tiny ear bones. It is connected to the nasopharynx (or back of the nose) by a tube called the eustachian tube. The eustachian tube’s role is to control the pressure in the middle ear, trying to equalize it with that of the surrounding atmosphere. It is for this reason that one senses “popping” in the ear when changing altitude. The eustachian tube is opening to allow the pressure of the middle ear and atmosphere to equilibrate. When this tube is not functioning properly, negative pressure develops in the middle ear, which can lead to a build-up of fluid and subsequent infection.

In young children, the eustachian tube is more horizontal than in adults and, therefore, often may not function properly. With growth and time, its function improves. The insertion of artificial tubes is done to temporarily solve the problem as the child grows and his eustachian tubles become, in a sense, more efficient.

Insertion of tympanostomy tubes is a frequently performed, safe, and effective procedure. It alleviates the pain and suffering associated with a miserable condition--that of recurrent ear infections. Done appropriately and in the right candidate, it can really improve quality of life, not only for the afflicted child but also for the entire family! It can allow a suffering little Katie to get on with the real business of a two-year-old...she has better things to scream about.

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