Myringotomy and Ear Tube Placement

Myringotomy tubes (also called tympanostomy tubes) are small tubes that are surgically placed into your child's eardrum by an ear, nose and throat surgeon. The tubes help drain fluid out of the middle ear in order to reduce the risk of ear infections. These tubes usually remain in place 6 to 18 months and may fall out by themselves. 

About one million children each year have tubes placed in their ears; it is one of the most common childhood surgeries performed in the U.S. Ear tubes are most commonly used for children who are 1 to 3 years old. By 5 years of age, most children have wider and longer eustachian tubes (a canal that links the middle ear with the throat area) that allow for better drainage of fluids from the ear. 

For children with chronic ear infections, ear tube insertion may be the solution to a very painful problem. 

What is Myringotomy?

To place ear tubes means that an incision is made in the ear drum. Immediately, any fluid that is behind the ear drum is removed. A small silicone tube is placed to keep a hole open and allow pressure behind the ear drum to remain equal to the pressure around us. Without fluid behind the ear drum or a build-up of pressure, the child should be much more comfortable, hear better and feel better.

Ear tube surgery generally takes just a few minutes and most children are able to go home the same day. In fact, most children can resume normal activities including school the following day. There is minimal or no pain to having ear tubes placed. 

When is a Myringotomy Needed?

The insertion of ear tubes may be recommended by your child's physician and/or an ear, nose and throat physician if several of the following conditions are present: 

  • Fluid in the ears for more than three or four months following an ear infection 
  • Fluid in the ears and more than three months of hearing loss 
  • Changes in the structure of the eardrum from ear infections 
  • A delay in speaking 
  • Repeated ear infections that do not improve with antibiotics over several months 

Generally, ear tubes can be considered for a child if fluid persists behind the ear drum for more than three months or if a child has experienced more than three episodes of acute otitis media (middle ear infection) in the last six months. Most of the time, children and even adults can have fluid stuck behind the ear drum that will resolve on its own. 

What is the Procedure Like?

Myringotomy is the surgical procedure that is performed to insert ear tubes. Insertion of the tubes is usually an outpatient procedure. The healthcare team that handles your child's procedure includes a surgeon, nurses and a pediatric anesthesiologist. 

The surgeon will handle placement of the tubes. Nurses prepare your child for the procedure, assist the physicians during the procedure and care for your child as they emerge from general anesthesia. The anesthesiologist, who has special training in pediatrics, will create and manage a plan of anesthesia for your child. 

Myringotomy involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained.  

Your child's pediatrician will manage the care of your child after the procedure. Your child's surgeon may order antibiotic ear drops to prevent infection. You will also be instructed on the use of earplugs while your child is in the water, based on the opinion of your child's physician. 

Call your child's physician if they experience drainage from the ear, ear pain, fever or displaced tubes (out of ear). 

For most children ear tubes will prevent ear infections. Ear tubes fall out after about one year – sometimes sooner and sometimes later. Once the ear tubes fall out and the hole in the ear drum heals, a child could get ear infections again. However, most children will only need one set of ear tubes and will grow out of having recurring ear infections. 

Risks & Benefits

The risks and benefits will be different for each child. It is important to discuss this with your child's physician and surgeon. Benefits of ear tubes include: 

  • Reduced risk of future ear infections 
  • Restored hearing in some children who experience hearing problems 
  • Child's behavior, sleep and communication may be improved if ear infections were the cause 
  • No negative impact on speech development 

Your physician will also discuss the risks of ear tubes, including: 

  • Ear infections may continue 
  • After tubes fall out (typically in one year), replacement may be needed if ear infections recur 
  • Tubes may need surgical removal if they remain in the ear too long 
  • Tubes may leave a small scar in the eardrum, potentially causing some hearing loss 
  • About 30% of children with tubes need tube replacement within five years 
  • Some children may develop an infection after the tubes are inserted 
  • Tubes may cause a small hole the eardrum that requires repair with surgery 

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