Myringotomy with Tympanostomy Tubes
Tympanostomy tubes, or PE (Pressure equalization) tubes, have been utilized for almost 60 years to equalize the pressure in the middle ear. The tubes, which come in various shapes and sizes, are placed through a hole made in the tympanic membrane, or eardrum, and allow for air to pass from the ear canal into the middle ear, which is the space that lies behind the tympanic membrane. Placement of tympanostomy is one of the most common surgical procedures in the U.S. In the normal middle ear, air passes from the back of the nose through the eustachian tube and provides ventilator airflow to the middle ear. In children, it is very common for the eustachian tube to function poorly. When the eustachian tube is not working correctly, the middle ear has a buildup of negative pressure, which can lead to fluid being drawn in from the surrounding tissue into the middle ear. The fluid can cause hearing loss by preventing the normal conduction of sound, and it can lead to bacterial infections known as bacterial otitis media.
Tubes are placed to either drain fluid from the middle ear or to allow air to come in from the ear canal and ventilate the middle ear. As such, they are often utilized to treat specific conditions such as otitis media and eustachian tube dysfunction. In young children, recurrent ear infections can lead to significant time missed from school, and chronic buildup of fluid behind the tympanic membrane due to recurrent otitis media can cause hearing loss than can lead to delay in speech development and potentially other developmental delays.
Tympanostomy (PE) tube placement is typically done under anesthesia for children. For many adults, tube placement can be done under local anesthesia in the office. The procedure is very quick and often takes less than 5 minutes to complete. A small incision is made in the tympanic membrane, and if there is any fluid in the middle ear, it is removed with a small suction device. The tube is then carefully placed into the newly created hole. Once placed, tubes tend to remain in the tympanic membrane anywhere from 6 months to 2 years, depending on the design of the tube. The tympanic membrane naturally “extrudes” the tube over time.
Recovery is fairly rapid after surgery. Most patients have either no pain or very minor discomfort. Patients are sometimes placed on antibiotic ear drops after surgery depending on surgical findings. PE tubes do preclude individuals from scuba diving or deep water swimming, but surface swimming can be done. In general, water exposure is ok and does not typically lead to middle ear infections, but earplugs are often utilized to ensure that no water passes through the PE tube into the middle ear.
Risks of Surgery
The placement of PE tubes is a very safe procedure, and can produce immediate and significant improvement in hearing and middle ear function; nevertheless, complications can potentially occur. One potential complication is a residual hole, or perforation, in the tympanic membrane after the PE tube falls out. This occurs in less than 2 percent of cases. If this occurs, a separate surgical procedure may be required to fix this hole. If the perforation occurs in a younger child, repair is typically delayed until the child reaches an age where he/she no longer has recurrent infections. Another potential complication is scarring of the tympanic membrane, known as tympanosclerosis. Though more common than perforations, this potential complication rarely produces any clinical symptoms. PE tubes can themselves become sources for recurrent infection, particularly if they have been left in place for an extended period of time. This may necessitate removal and replacement of the tubes. Bleeding and hearing loss are other potential, yet exceedingly rare, complications of PE tube placement.