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.