What is Ear Tube Surgery? In Which Situations and How Is It Performed?

Fluid accumulation in the ear is one of the leading causes of hearing problems in childhood. The question of how ear tube surgery is performed is one of the most curious topics for families facing this situation. This procedure is performed by placing a small tube into the eardrum that balances the pressure between the middle ear and the external environment.

In this article, we will discuss in detail how ear tubes are inserted, the surgical process, how the tube in the ear falls out, and how the tube in the ear is removed.

What is Ear Tube Surgery?

An ear tube is a small medical device called a ventilation tube or tympanostomy tube in medical terminology. This cylinder-shaped apparatus, which is surgically placed into the eardrum, provides air passage between the middle ear and the external environment.

Normally, there is air in the middle ear, and this ventilation occurs through the Eustachian tube. However, when the Eustachian tube does not function properly for various reasons, negative pressure occurs in the middle ear. In this case, the ear tube comes into play and provides an alternative ventilation path to the Eustachian tube.

What does an ear tube look like?

Although ear tubes have different designs, the most commonly used shape resembles a thread spool. Like the channel in the middle of a spool, these tubes also have a hole in the center. Thanks to this hole, air enters and exits the middle ear.

In thread spool-shaped tubes, there are two separate sections remaining behind and in front of the eardrum. The narrow part in the middle acts as a constriction. The wide sections on both sides of this constriction are called flanges. When the tube is placed in the eardrum, the flange on the middle ear side is wider, thus preventing the ear from easily expelling the tube.

Apart from this, T-shaped tubes are also available. A tube-like channel extends along the vertical stem of the T-tubes. The arms extending to the right and left at the top of the T-shape have a flexible flange structure. When these tubes are inserted, their flanges remain on the middle ear side and stay fixed in the ear until removed by the physician.

Functions of the ear tube

The primary task of the ear tube is to ensure the ventilation of the middle ear. It reduces the risk of infection by providing drainage for the fluid accumulated in the middle ear. It also prevents hearing loss by balancing the pressure between the middle ear and the external environment.

Thanks to the tube, it becomes possible for the middle ear ossicles to move normally again. With the provision of normal air entry into the middle ear, the development of honeycomb-like cells within the ear bone also returns to normal. It provides comfort by ensuring air exchange between the middle ear and the external environment, especially in situations where air pressure changes rapidly, such as during air travel.

Types of ear tubes

Ear tubes can be produced from different materials. There are varieties made of silicone, plastic, propylene, Teflon, stainless steel, titanium, and gold. Silicone material is the most commonly preferred because it is biocompatible.

Tubes are divided into two main categories in terms of duration. Short-term tubes remain in the eardrum for an average of 6-12 months and fall out on their own. Long-term tubes remain in the ear for more than 1 year, or even 2-3 years. These tubes have a wider channel compared to short-term ones.

In children, simple tubes made of plastic, such as propylene, which the body can easily expel, are generally preferred for temporary problems related to adenoids. In cases where long-term ventilation is required, silicone, gold, or specially shaped tubes are used. Long-term tubes are recommended for children with cleft palate or for individuals who have previously had a short-term tube inserted but the disease has recurred.

In Which Situations Is an Ear Tube Inserted?

The decision for ear tube surgery is made in the presence of specific medical conditions and when there is no response to drug treatment. 80 percent of children experience fluid accumulation in the middle ear at least once by the age of 10. However, surgery is not immediately necessary in every case of fluid accumulation.

Fluid accumulation in the middle ear

Fluid accumulation in the middle ear is the most common reason for ear tube insertion. Fluid accumulates in the middle ear cavity as a result of the Eustachian tube being blocked or not functioning properly. This fluid causes hearing loss by preventing the transmission of sound waves to the inner ear.

In the first stage, drug treatment is applied. If fluid accumulation persists for more than 3 months, ear tube insertion is recommended. However, in some cases, this period is not waited for. If there is retraction in the eardrum, if there is bilateral 30-40 dB hearing loss, or if there is a risk of permanent hearing loss, it is appropriate to insert a tube as soon as possible.

Adenoid enlargement in children often accompanies fluid accumulation in the middle ear. Enlarged adenoids compress the opening of the Eustachian tube and impair middle ear ventilation. Therefore, ventilation tube application is often combined with adenoid surgery.

Chronic ear infections

Ear tubes are considered for children who have 4 or more middle ear infections per year. Recurrent infections can make the fluid in the middle ear permanent. In this case, the fluid thickens over time and a glue ear condition occurs.

Surgical treatment comes to the agenda in chronic infections that do not respond to antibiotic treatment. If damage has occurred in the eardrum and there is discharge due to infection, an ear tube can be used to drain the fluid after the eardrum is repaired.

Eustachian tube problems

The Eustachian tube is the channel connecting the middle ear to the nasopharynx. In case of blockage or dysfunction of this channel, the pressure balance in the middle ear is disrupted. Colds, sinus infections, and allergies cause the Eustachian tube to swell or become blocked with mucus.

If there is a disease in the nasopharyngeal region that covers the opening of the Eustachian tube, a problem occurs. Allergic rhinitis impairs Eustachian tube function due to the nasal mucosal edema it triggers. In addition, Eustachian tube development may be insufficient in conditions such as structural defects, Down syndrome, and cleft palate.

Ventilation tube application is an effective solution for Eustachian dysfunction that does not respond to treatment. Sudden pressure changes resulting from barotrauma can also lead to fluid accumulation in the middle ear.

Hearing loss conditions

There is a decrease in hearing in the presence of fluid in the middle ear. People hear sounds as muffled, distant, or faint. When hearing loss exceeds the 20 dB threshold, ear tube insertion is recommended.

Especially in children, this situation negatively affects school success and speech development. They turn up the volume of the television, have to watch it closely, or make people repeat what is said. Distractibility and a decline in school success occur.

In adults, unilateral fluid accumulation should be evaluated carefully. The priority is to identify and treat the underlying cause leading to fluid accumulation. A tube can be inserted when retraction is observed in the eardrum or when there is no response to drug treatment.

How Is an Ear Tube Inserted?

The answer to the question of how ear tube surgery is performed actually involves a fairly simple process. This procedure is a planned surgical intervention and is performed in an operating room environment.

Preoperative preparation

A comprehensive evaluation is performed before the surgery. The patient's ear examination is examined in detail, and the level of fluid accumulation in the middle ear is measured. A hearing test and middle ear pressure test are definitely performed. These tests reveal the density of the fluid and its effect on hearing.

The patient's general health status is reviewed. The surgeon provides information about potential risks before the surgery. Especially in pediatric patients, paying attention to the fasting period on the morning of the surgery is of vital importance for anesthesia safety. If there are any medications used, these should be shared with the doctor.

Anesthesia procedure

The type of anesthesia varies according to the patient's age. In pediatric patients, the procedure is performed under general anesthesia. Thanks to general anesthesia, the child sleeps during the surgery and feels nothing. In adult patients, the procedure can be performed by numbing the ear regionally.

Local anesthesia is applied using two different methods. In the first method, the anesthetic drug is given by injection. In the second method, the drug is dripped directly onto the eardrum. Both methods provide sufficient numbness in the area.

The process of placing a tube into the eardrum

After the anesthesia takes effect, the actual procedure begins. The surgeon works under a microscope. The microscope allows for a detailed view of the ear structure. First, the ear canal is cleaned, and the eardrum is cleared.

A small incision is usually made in the lower-anterior region of the eardrum. This incision is approximately 1-2 millimeters wide. The fluid accumulated in the middle ear is vacuumed out through this hole opened using a laser or scalpel. If necessary, a sample can be taken from the fluid.

Then, the small tube is placed into this incision. One end of the tube remains in the middle ear, and the other end remains in the external ear canal. Thus, air passage is provided between the middle ear and the external environment. No stitches or dressings are required for this procedure. Antibiotic ear drops may be applied to reduce the risk of infection.

Surgery duration

Ear tube surgery takes a very short time. It is an average 5-minute procedure. According to some sources, the procedure takes 15 minutes. In general, the surgery is completed between 15-20 minutes. The patient is discharged on the same day and can go home.

If there is adenoid enlargement during the procedure, the adenoids can also be removed in the same session. The reason for this is that recurrences are seen less frequently when both procedures are performed together.

Post-Ear Tube Surgery Process

After the surgery is completed, the follow-up process begins. In this period, how long the tube will stay in the ear, how it will fall out, and what rules should be followed are important.

How long does the ear tube stay in the ear?

The duration the tube stays in the ear depends on the type of tube used. Short-term tubes stay in the ear for an average of 6-12 months. According to some sources, this period can vary between 6-18 months. In patients who have an ear tube inserted for the first time, short-term tubes are usually chosen, and these tubes stay for 6-9 months.

Long-term tubes stay in the ear for longer periods, such as 12-24 months. Specially designed tubes like T-tubes can stay for 15-24 months. It is stated that standard tubes used in children function for an average of 4-18 months.

Tubes provide benefits as long as they remain in place. Under normal conditions, a tube working healthily for 9 months is considered sufficient.

How does the tube in the ear fall out?

As the ear disease heals, the eardrum eventually expels the tube into the ear canal. The vast majority of tubes, at a rate of 95 percent, fall out on their own. This process is completely natural, and no additional intervention is required.

When the tube falls out, it is often not noticed. This is because the tube does not come out of the ear canal, and it is not possible for you to see it fall out. During the doctor's follow-up examination, the doctor sees that the tube has been expelled into the external ear canal and removes it.

The tube falling out earlier than expected may cause fluid to accumulate in the middle ear again. In such cases, the tube may need to be reinserted surgically. The child jumping, running, or playing sports does not cause the tube to fall out.

How is the tube in the ear removed?

If the tube does not fall out on its own and remains in place for between 12 months and 3 years, it must be removed by a doctor. If the tube has not fallen out despite exceeding 2 years, it is removed with a simple intervention.

In pediatric patients, the tube can be removed after inhaling a light anesthetic gas. Long-term T-tubes cannot be expelled by the body under normal conditions and are removed by the physician. Excluding ear discharge that does not stop with drug treatment, there is no need to remove a tube that is not expelled.

After the tube falls out, the small hole in the eardrum usually closes on its own within a few weeks. However, a permanent hole in the eardrum can be seen at a rate of 1-2 percent.

Things to consider after surgery

Keeping water out of the ear is the most important rule. The external ear flora is rich in microbes, and due to the tube, there may be a passage of microbes into the middle ear. It is necessary to cover the ear canal with silicone plugs or cotton with Vaseline during bathing.

Protective earplugs must be used when entering the sea or pool. Deep diving should be avoided. Upper respiratory tract infections can affect the middle ear.

In case of discharge from the ear, a doctor should be consulted. In case of prolonged discharge, the tube may need to be removed early. Regular follow-up examinations should not be neglected.

Recovery process

The recovery process is usually fast. A slight feeling of discomfort is normal, but severe pain should be reported. Post-operative pain is usually mild and disappears within a few days.

The patient is discharged on the same day and can return to normal activities within a few hours. Hearing loss disappears significantly after surgery. The drops and medications recommended by the doctor should be used regularly.

Frequently Asked Questions About Ear Tube Surgery

Patients ask many questions before and after the surgery. These questions are frequently raised, especially by families whose children will have ear tubes inserted. Here are the most curious topics and their answers.

Since inserting a tube into the ear is a painful procedure, it is definitely performed under anesthesia. The eardrum is rich in nerve fibers, and even touching it causes pain. Therefore, you will definitely not feel pain during the surgery.

General anesthesia is applied to children. There is no pain after the surgery either. In adults, local anesthesia is sufficient. Once the tube is placed in the eardrum, it does not cause any discomfort as long as it is there.

When the procedure is completed, a slight feeling of fullness may be experienced, but this is normal. It disappears within a few days. Severe pain is not expected.

No, the tubes inserted into the ear are not visible when viewed from the outside. The tube is placed in a structure located in the middle ear that supports the eardrum. It is in the shape of a small cylinder or ring.

It can be seen when looking into the ear during an examination. The doctor checks the tube with a microscope. However, under normal conditions, no one notices it. Besides, you do not need to worry about it from an aesthetic point of view.

Since the integrity of the eardrum is compromised, it is possible for water to get into the middle ear. The external ear flora is very rich in microbes, and there may be a passage of microbes into the sterile middle ear.

When water gets in, it travels from the tube's channel into the middle ear. In this case, purulent inflammation formation is observed. The ear becomes inflamed and starts to discharge. Bacteria found especially in dirty water increase the risk of infection.

Cotton with Vaseline should be used to protect the ear from water. Cotton and Vaseline are mixed together to obtain a thick consistency like dough. This material is pressed into the ear canal to prevent water passage. Precautions must be taken when entering the sea or pool.

Ear tube surgery is a reliable treatment method. Its risks are extremely low. Since it is one of the frequently performed surgeries, it carries minimal risk.

A permanent hole in the eardrum can be seen at a rate of 1-2 percent. Even if the tube is expelled, the hole may not close. It may cause calcification in the eardrum, but it is harmless and does not affect hearing.

If not performed properly, the tube may escape into the middle ear, get lost, become infected, or become blocked. It may be a cause of ear discharge. If it lasts for a long time, the tube may need to be removed early.

If fever and vomiting occur, it is necessary to consult a doctor immediately. These are not normal symptoms. Mild bloody ear discharge is possible in the first 1-2 days after surgery. However, if green or yellow discharges have a foul odor, a physician should be consulted.

There is no age limit for ear tube insertion. It can be applied at any age. It is a procedure frequently applied, especially in children.

When it is observed that fluid has accumulated in the middle ear, if the fluid does not clear despite being given treatment for a few weeks, a tube must be inserted. Intervention is performed when hearing deficiency reaching up to 30 percent occurs.

In adults, a tube can be inserted when retraction is observed in the eardrum or when there is no response to drug treatment. Medical necessity, not age, is the determining factor.

In Summary, Ear Tube Surgery

Although ear tube surgery may seem scary at first, it is actually a simple and safe procedure. Consult your doctor when you notice constant ear infections or hearing loss in your child. Thanks to the insertion of a tube, the fluid in the middle ear is drained, hearing improves, and the risk of infection decreases. The surgery takes only a few minutes, and you can return home on the same day.

Protecting the ear from water after surgery and going for regular check-ups is sufficient. Above all, this procedure, performed at the right time, significantly improves your child's quality of life. If you have doubts, consult an expert ear, nose, and throat doctor to make the most accurate decision.

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