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Ear Tubes

• What are risks and complications of ear tubes?
• What happens before surgery?
• What to do the day of surgery?
• What happens during surgery?
• What happens after surgery?
• What are the general instructions and follow-up care?
• Ear Tubes At A Glance

The following information is provided to help you prepare for your child's surgery, and to help you understand more clearly the associated benefits, risks, and complications. You are encouraged to ask your doctor any questions that you feel necessary to help you better understand the above procedure.

A myringotomy is a surgically placed tiny incision in the eardrum. Any fluid, usually thickened secretions, will be removed. In most situations, a small plastic tube (a tympanostomy tube) will be inserted into the eardrum to keep the middle ear aerated for a prolonged period of time. These ventilating tubes usually remain in place for 6 months to several years. Eventually, they will move out of the eardrum (extrude) and fall into the ear canal. Your doctor may remove the tube during a routine future office visit or it may simply fall out of the ear without your child realizing it.

The following instructions are designed to help your child recover from his/her myringotomy and tympanostomy tube placement as easily as possible. Taking care of your child can prevent complications.

What are risks and complications of ear tubes?

Your child's surgery will be performed safely and with care in order to obtain the best possible results. The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning potential aspects of the surgical procedure for ear tube insertion.

• Failure to resolve the ear infections.
• Persistent perforation after the tube falls out of the eardrum.
• Chronic ear drainage.
• Need for further and more aggressive surgery such as tonsil, adenoid, sinus, or ear surgery.
• Infection.
• Hearing loss.
• Scarring of the eardrum.
• Need to keep the ear dry and to use ear plugs.
• Foreign body reaction to the tube itself - for example, an allergic reaction to the tube material (rare).

What happens before surgery?

In most situations, the surgery is performed as an outpatient, at either the hospital or the surgicenter. In both facilities, quality care is provided without the expense and inconvenience of an overnight stay. An anesthesiologist will monitor your child throughout the procedure. Usually, the anesthesiologist will review the medical history before surgery, often the evening prior. If he or she is unable to reach you the night before surgery, they will talk with you that morning. If your doctor has ordered preoperative laboratory studies, you should arrange to have these done several days in advance.

It is advised that you be honest and up front with your child as you explain their upcoming surgery. Let them know that they will be safe and that you will be close by. A calming and reassuring attitude will greatly ease your child's anxiety. You can assure them that most children have minimal, if any pain afterward. In fact, most children will feel better having had the pressure relieved in their ears.

Your child must not eat or drink anything 6 hours prior to their time of surgery. This includes even water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication.

If your child is sick or has a fever the day before surgery, call the office. If your child wakes up sick the day of surgery, still proceed to the surgical facility as planned. Your doctor will decide if it is safe to proceed with surgery. However, if your child has chickenpox , do not bring your child to the office or to the surgical facility.

What to do the day of surgery?

It is important that you know precisely what time you are to check in with the surgical facility, and that you allow sufficient preparation time. Bring all the required papers and forms with you, including the preoperative orders and history sheets. Your child should wear comfortable loose fitting clothes (pajamas are permissible). Leave all jewelry and valuables at home. They may bring a favorite toy, stuffed animal, or blanket.

What happens during surgery?

In the operating room, the anesthesiologist will usually use a gas anesthetic. For older children, a mixture of gas and an intravenous medication may be utilized. During the procedure, your child will be continuously monitored including pulse oximeter (oxygen saturation) and cardiac rhythm (EKG). The surgical team is prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room.

After the anesthetic takes effect, the doctor, using an operating microscope, makes a tiny incision in the eardrum through the outer ear canal. There will be no external incisions. Fluid will be suctioned from the ear, and a tube inserted in the eardrum. Usually, drops will be placed in the ear, and a cotton plug inserted in the ear canal. The whole procedure usually takes less than 15 minutes. Your doctor will generally come to the waiting room to talk with you once your child is safely to the recovery room.

What happens after surgery?

After surgery, your child will be taken to the recovery room where a nurse monitors your child. You will probably be invited into the recovery room as your child becomes aware of their surroundings and starts looking for you. Your child will be able to go home the same day as the surgery once they have fully recovered from the anesthetic. This usually takes less than one hour.

Your child may resume a normal diet after he or she has fully recovered from the anesthetic. Even though they may be hungry immediately after surgery, it is best to feed them slowly to prevent postoperative nausea and vomiting. Occasionally, children may vomit one or two times immediately after surgery. However, if vomiting persists, your doctor may prescribe medication to settle the stomach.

What are the general instructions and follow-up care?

An appointment for an ear checkup should be made 10 to 14 days after the procedure. At this visit, the position and function of the tubes will be assessed. Call the office to schedule this appointment.

Usually, two different types of ear drops will be given to you the day of surgery. Cortisporin ear drops (or its generic) is to be used immediately after surgery for 3 days (3-4 drops each ear 3 times per day). If there is drainage from the ear after 3 days, continue to use the drops until the day before your office visit. Discontinue these drops if they cause severe pain or a skin rash develops. You should substitute Vasocidin drops if any of these problems develop. Vasocidin drops are to be used in the ear if water accidentally enters the ear canal. This will help prevent water contamination related ear drainage. Vasocidin drops are actually an eye medication, but we prescribe them as a safe gentle medication for the ears. Both drops should be warmed by holding them in the hand for 5 minutes and inserting into the ear canal along the side. You can "pump" them into the ear by pushing on the soft cartilage tissue located in front of the ear canal (medically termed the tragus).

Ear drainage may occur immediately after the procedure or at any time while the tubes are in place. Yellow clear fluid or mucous may drain for several days to weeks after the surgery. It is not unusual to see a bloody discharge following surgery. Cotton can be kept in the ear canal and should be changed as needed to keep dry. If after the immediate post operative period, profuse, foul-smelling discharge drains from the ear, an infection is indicated. When this occurs, you should begin by using ear drops for 3 days. If the drainage continues beyond 3 days, then you should call the office to determine if additional medicine and/or an office visit is necessary.

Water should not be allowed to enter the ear canal while the tubes are in place. Because there is now a passage into the middle ear to allow for ventilation, water can also pass into the middle ear space. If this occurs, ear drainage and infection may follow. It is recommended that all children try to utilize ear plugs whenever there is a chance of water contamination (swimming, bathing, washing hair). Bathing caps or "ear bandits" are also helpful. The office can help you with ear plugs.

Tympanostomy tubes usually stay in place from 6 months to several years. It is important to have an ear checkup about every 6 months during this time period. An audiogram is usually obtained at some point after the ear has healed. The tubes will eventually fall out of the eardrum and into the ear canal. Some children will note some mild discomfort or bloody drainage at this time. The small hole in the eardrum at the old tube site usually heals within several weeks. Your doctor will instruct you when it is safe to allow water in the ears.

Ear Tubes At A Glance

• Ear tube placement involves a tiny incision in the ear drum.
• Ear tubes can have complications.
• It is helpful to understand what to expect before, during, and after surgery.
• Water should not be allowed to enter the ear canal while the tubes are in place.

Last updated on 05/15/2008

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