Patient Information for Myringotomy Tubes

Middle-ear ventilating tubes are used to treat eustachian-tube dysfunction and its complications. The eustachian tube is responsible for ventilating and draining the space behind the eardrum into the back of the nose. If the eustachian tube is obstructed, the space behind the ear will not drain, and fluid may collect. If there are bacteria present, it may become infected. Possible causes include bad colds, allergy reactions, enlarged adenoids, chronic sinusitis, and anything else which may cause the tissue in the back of the nose to swell. The middle-ear ventilating tubes simply bypass the faulty eustachian tube and allow the ear to drain to the outside through the ear canal. Approximately 80% of individuals having ventilating tubes will not require placement of tubes after the first set is gone. Twenty percent of individuals having tubes may require more than one set if trouble develops after the first set falls out. This does not mean the tubes "failed." The individual has simply remained ear-infection prone, and the tubes are no longer there to help.

Middle-ear ventilating tubes are small plastic or metal tubes, which are designed to artificially ventilate the middle-ear space behind the eardrum. These tubes are inserted through a small, surgically produced hole in the eardrum and are generally left in place until such time as they spontaneously come out. All of these tubes have some kind of flange or similar device on at least one side to keep them from slipping out of the small hole which is made in the eardrum. The short operative procedure is usually performed under general anesthesia for infants and children. In most teen-agers and adults, the operation can be done in the office under a mild form of local anesthesia. If there is fluid in the middle ear at the time of surgery, most of it is removed.

The average time for tubes to remain in the eardrum is 12 months. Some will come out within 2-3 months, some may stay 2-3 years. The tubes generally come out because the eardrum heals behind the tubes and literally pushes the tube out of the eardrum. 98-99% of the time, the eardrum will be totally healed when the tube comes out. In less than 1% of cases, a small hole may remain in the eardrum for an extended period. This hole may require surgical closure at some later date.

The major problems related to placement of middle-ear ventilating tubes include the following:

1.	With infants and small children, a short general anesthetic is required. There is always some risk of heart, lung, or other serious problems developing with general anesthesia. Serious problems are extremely rare and occur perhaps no more frequently than 1 in 100,000 cases.
2.	Occasionally, the tube itself may act as a source of infection, or may cause a "foreign?body" reaction, which causes ear drainage and perhaps mild bleeding, but usually no pain and rarely is a serious problem.
3.	A persistent hole will remain in the eardrum after the tube comes out in less than 1% of patients.
4.	Rarely, the individual having a tube placed in his eardrum will notice some slight drop in the hearing, rather than an improvement. This is extremely rare and generally only occurs in adults.

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