It is important to remember that the tube does not “fix” the underlying problem (immature Eustachian Tube function and poor ear ventilation). No surgical intervention can fix this problem except growth and development. While some children take longer to out grow ear disease than others, very few children still have this problem past age 8. The tubes simply act as a “way to buy time” as the child grows or in adults to allow swelling to resolve in adult patients. Ear tubes work by bypassing the problem and ventilating the ears through the eardrum. Therefore ear infections and ear fluid are reduced or prevented. By the time the tubes come out, most children have grown enough to ventilate their ears on their own – approximately 10 % of children may need to have tubes placed more than once.
There are two basic types of tubes- short acting and long acting. Although there are dozens of styles and brands, most fall into one of these two categories. Each surgeon has his or her own preferences regarding tube selection. Generally, short acting tubes are used in children without other underlying problems (see below) for their first or second set of tubes. These tubes reliably fall out of the eardrum within 6 months to a year after placement.
Long acting tubes are used with children suspected of having severe, long-term Eustachian tube problems. Such problems may be seen in children with cleft palate, Down syndrome, various head and neck syndromes, or older children who have had longstanding ear problems and severe collapse of the eardrum. While the long-term tubes make replacement surgery less likely, they have a greater chance of leaving a persistent hole in the eardrum after they fall out or are removed, which would then require more extensive surgery to repair. For this reason, I rarely recommend long term tubes in children and only recommend long term tubes in adults if their problems are persistent.
For children ear tubes are placed under general anesthesia through the ear canal using a microscope. After cleaning out the wax from the ear canal, a tiny hole is made in the eardrum with a small knife, and any fluid is suctioned from the ear. The tube is then inserted into the hole, where it stays in place due to its flared ends (it is shaped like a spool of thread). No skin incision or sutures are used, nothing is visible from the outside, and the entire operation usually takes less than ten minutes for each side. Most parents are very concerned about the anesthesia, but this is extremely safe. For adults who can withstand the discomfort of the procedure tubes are placed in the office with a topical anesthesia applied to the ear drum. This can be a rather uncomfortable procedure so I rarely recommend placement of ear tubes in the office in children.
In some cases removal of the adenoids will be recommended when tubes are placed. The theory behind this practice is that the adenoids sit at one end of the Eustachian tube (in the back of the nose), and may contribute to ear infections and fluid . There are several theories as to why the adenoids have this effect. One of which is that they physically block the Eustachian tube, interfering with its function. Another theory is that they provide a place for bacteria to grow which then inflames the Eustachian tube, or bacteria from the adenoids travel up the eusthacian tube into the ear causing infections.
Adenoidectomy adds a small amount of time and risk to the surgery, and like all operations, should not be done unless there is a good reason. Adenoidectomy may be recommended if your child has required a previous set of ear tubes or has symptoms which suggest blockage of the nose by the adenoids such as snoring, mouth breathing or recurrent infections.