Otolaryngology - Head and Neck Surgery

Myringotomy and PE Tubes

Illustration of the proximity of the ear drum to adenoid tissue and Eustachian tube

Fluid in the middle ear of children is common and is usually a result of Eustachian tube dysfunction. The Eustachian tube connects the back of the throat behind the nose with the middle ear and allows to enter the middle ear so that the ear may function normally.

We have all experienced situations in which the Eustachian tube has not worked well. For example, the pressure we feel in our ears when riding the elevator in a tall building or during takeoff or landing in an airplane is a result of the Eustachian tube temporarily not allowing the air in the middle ear to equalize with the surrounding environment.

In children, the Eustachian tube does not always mature to the level of normal function at the same rate and may not work as efficiently as in adults for considerable periods of time. The adenoid are located near the nasal opening of the Eustachian tube and may prevent normal functioning of the tube due to inflammatory reactions. Allergies and sinus infections sometimes cause congestion about the opening of the tube and thereby impair its capacity to open properly. All of these factors will prevent air from entering the middle ear. When this occurs over a period of time, the air in the middle ear is absorbed by the body and replaced by a fluid. The fluid itself does not cause any damage to the ear although its presence can impair hearing as well as serve as a medium for bacteria to grow. When bacteria are present, it causes an infection which is treated with an antibiotic. Although the antibiotic will cure the ear infection, if the fluid in not cleared from the middle ear space then another infection can develop once the child is off the antibiotics. After repeated infections the bacteria may become resistant to certain antibiotics so another antibiotic is used.

Decongestants are frequently used in an attempt to open the Eustachian tubes and drain the fluid from the middle ear. In some cases the fluid may resolve along with the infection, but because of the marginal function of the Eustachian tube, a minor cold or other disturbance may then cause a buildup of fluid and lead to another ear infection.


Illustration of the placement of a PE tube between the middle ear and the ear canal

There are children in whom the repeated use of antibiotics and decongestants does not permanently remove the fluid. Therefore, an operation is indicated. The procedure most commonly used is called a myringotomy and placement of pressure equalization ("PE") tubes. The operation is usually done as a "day surgery" with the patient arriving at the hospital early in the morning and leaving later that same day. With the patient asleep, the surgeon makes a small incision in the eardrum and removes the fluid. A small plastic or metal tube is then placed in the incision so that air can enter the middle ear to help prevent the fluid from reforming.

The tube will remain in the ear drum for a variable length of time with an average of six months. In many children the tube will eventually be extruded and the incision in the ear drum will close. By this time the ear will have had a chance to resolve the chronic inflammatory state and the Eustachian tube will be better developed to function normally. In certain patients, an adenoidectomy (removal of the adenoid tissue) is performed along with the myringotomy in an effort to allow the Eustachian tube to resume normal function. In other patients an allergic assessment, especially if the problem recurs, may be need to be done to help alleviate the problem. In some children, in addition to adenoidectomy and allergic assessment, a dental evaluation and other types of studies have to be done in order to understand the problem.

Postoperatively, it is very important that no water enter the ear canal as it may pass through the tube and into the middle ear and cause an infection. This is accomplished by the use of vaseline-impregnated cotton or plastic plugs placed in the ear when bathing. The ear should not be cleaned except by the physician and if drainage from the ear occurs, it should be promptly reported to the doctor.

Please be sure that you discuss the surgery with your physician so that he may answer, in detail, any question you may have.