Ear tube surgery

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Types of eardrum repair procedures

Causes of a perforated eardrum

Complications from eardrum repairs

During the eardrum repair surgery

After an eardrum repair procedure

Why do we need tympanostomy?

Eardrum repair is a surgical procedure used to fix a hole or tear in the eardrum, also known as the tympanic membrane. This surgery can also be used to repair or replace the three tiny bones behind the eardrum.

The eardrum is a thin membrane between your outer ear and your middle ear that vibrates when sound waves hit it. Repeated ear infections, surgery, or trauma may cause damage to your eardrum or middle ear bones that must be corrected with surgery. Damage to the eardrum or middle ear bones can result in hearing loss and an increased risk of ear infections.

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Types of eardrum repair procedures

  1. Myringoplasty

If the hole or tear in your eardrum is small, your doctor may first try to patch the hole with gel or a paper-like tissue. This procedure takes 15 to 30 minutes and can often be done in the doctor’s office with only local anesthesia.

  1. Tympanoplasty

A tympanoplasty is performed if the hole in your eardrum is large or if you have a chronic ear infection that cannot be cured with antibiotics. You will most likely be in the hospital for this surgery and will be placed under general anesthesia. You will be unconscious during this procedure.

First, the surgeon will use a laser to carefully remove any excess tissue or scar tissue that has built up in your middle ear. Then, a small piece of your own tissue will be taken from a vein or muscle sheath and grafted onto your eardrum to close the hole. The surgeon will either go through your ear canal to repair the eardrum, or make a small incision behind your ear and access your eardrum that way.

This procedure typically takes two to three hours.

  1. Ossiculoplasty

An ossiculoplasty is performed if the three tiny bones of your middle ear, known as the ossicles, have been damaged by ear infections or trauma. This procedure is also performed under general anesthesia. The bones can be replaced either by using bones from a donor or by using prosthetic devices.

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Causes of a perforated eardrum

A hole in the eardrum can be caused by:

  • an ear infection
  • an injury to the eardrum, such as a blow to your ear or poking an object like a cotton bud deep into your ear
  • changes in pressure, such as while flying or scuba diving
  • a sudden loud noise, such as an explosion

The following tips may help you avoid damaging your eardrum:

  • see a GP for treatment if you have symptoms of an ear infection for more than 2 or 3 days
  • do not push anything deep into your ears, including your fingers
  • wear suitable ear protection if you’re often exposed to loud noises
  • when flying, try swallowing, yawning, chewing gum or sucking on a boiled sweet during take-off and landing

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Complications from eardrum repairs

There are risks involved with any type of surgery. Risks can include bleeding, infection at the surgery site, and allergic reactions to medications and anesthesia given during the procedure.

Complications from eardrum repair surgery are rare but can include:

  • damage to your facial nerve or the nerve controlling your sense of taste
  • damage to the bones of your middle ear, causing hearing loss
  • dizziness
  • incomplete healing of the hole in your eardrum
  • moderate or severe hearing loss
  • cholesteatoma, which is an abnormal skin growth behind your eardrum

What happens during surgery for a perforated eardrum

Surgery to repair a burst eardrum is usually done in hospital under general anaesthetic (where you’re asleep).

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During the eardrum repair surgery

a small cut is made just in front or behind your ear and a small piece of tissue is removed from under your skin – this will leave a small scar, which will usually be covered by your hair

small surgical instruments are used to patch the hole in your eardrum with this piece of tissue – this may be done through your ear opening, or through a small cut made next to your ear

a dressing is placed in your ear to hold the patch in place and stop water and germs getting in – this usually stays in place for about 2 or 3 weeks

cotton wool padding is put over your ear and held in place with a bandage

the cut(s) in your skin are closed with stitches

Most people can go home on the same day or the day after the operation.

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After an eardrum repair procedure

After your surgery, your doctor will fill your ear with cotton packing. This packing should remain in your ear for five to seven days after your surgery. A bandage is usually placed over your entire ear to protect it. People who undergo an eardrum repair procedure are typically released from the hospital immediately.

You may be given ear drops after the surgery. To apply them, gently remove the packing and put the drops in your ear. Replace the packing and don’t put anything else in your ear.

Try to prevent water from entering your ear during recovery. Avoid swimming and wear a shower cap to keep water out when you bathe. Do not “pop” your ears or blow your nose. If you need to sneeze, do so with your mouth open so that pressure does not build up in your ears.

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Why do we need tympanostomy?

An ear tube is used most often to provide long-term drainage and ventilation to middle ears that have had persistent fluid buildup, chronic middle ear infections or frequent infections.

  • Normal ear ventilation

Ventilation of the middle ear is normally accomplished by the eustachian tubes — narrow tubes that run from each middle ear to high in the back of the throat. The throat end of each tube opens and closes to:

  • Regulate air pressure in the middle ear
  • Refresh air in the ear
  • Drain secretions from the middle ear

Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection or allergy can block the tubes, causing the accumulation of fluids in the middle ear. This problem is more common in children, in part because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.

  • Ventilation with ear tubes

Ear tubes provide an alternative airway to keep the air in the middle ear refreshed, allow for drainage and equalize the pressure inside the ear with air pressure outside the body. The tubes are most often used in children with one of the following conditions:

  • Fluid trapped behind the eardrum results in inflammation and fluid buildup (effusion) in the middle ear with or without bacterial or viral infection. This may occur because the fluid buildup persists even after an ear infection has resolved. It may also occur because of some dysfunction or noninfectious blockage of the eustachian tubes.
  • Hearing loss often results from otitis media with effusion, which is middle ear infection in trapped fluid. Hearing loss can lead to delays in speech development, communication problems, behavior problems and poor school performance.
  • Middle ear infections are generally considered frequent if there are three or more distinct episodes in six months or four or more episodes in a year. Ear tubes may help prevent recurring infections.
  • Chronic middle ear infections are long-term infections of the middle ear that don’t improve with antibiotic treatment.
  • Chronic suppurative otitis media is a persistent ear infection that may result in tearing or perforation of the eardrum.

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Risk of ear tube surgery

Ear tube surgery is a safe procedure and doesn’t pose much serious risk. However, your child could have:

  • Bleeding or infection
  • Scars or weakness in the eardrum
  • Tubes that fall out
  • Drainage of ear fluid that doesn’t stop
  • Blockages in the tubes from blood or mucus
  • Eardrums that don’t close after tubes are removed

Some children have problems after being under anesthesia, and may have:

  • An allergic reaction
  • Trouble breathing
  • Heart irregularities
  • Nausea or vomiting

During recovery, talk to the doctor if your child has:

  • Yellow, brown, or bloody ear discharge for more than a week
  • Pain
  • Hearing problems
  • Balance problems

Before ear tube surgery

A surgeon specializing in ear, nose and throat disorders performs the surgery for placing ear tubes.

The surgeon usually performs the procedure during general anesthesia, so your child isn’t aware of anything during the procedure. The anesthetic medication may be inhaled through a mask, injected into a vein or both.

The surgical team places several monitors on your child’s body to help make sure that his or her heart rate, blood pressure and blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on the child’s arm and heart-monitor leads attached to your child’s chest.

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During ear tube surgery

Ear tube surgery (myringotomy) is usually performed while the patient is under general anesthesia (put to sleep). It can also be done in adults with a local anesthetic (the patient remains awake).

The surgeon makes a small incision (cut) in the eardrum. The incision can be made with a scalpel or with a laser.

The fluid that is trapped in the middle ear is drained or suctioned out.

The doctor then inserts the tube into the incision in the eardrum to allow fluid to drain out of the ear.

In some cases, the surgeon may also remove the adenoids (glands that are located above the roof of the mouth and behind the nose). Adenoids are part of the immune system and help protect the body from viruses and bacteria. Removing the adenoids may prevent the need for future ear tube surgeries.

Ear tube surgery is performed in the hospital or in the doctor’s office. It usually takes less than 15 minutes, and the patient goes home the same day (outpatient surgery).

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After ear tube surgery

The patient will spend some time in the recovery room after ear tube surgery. He or she may have some side effects from the surgery and anesthesia, including grogginess and nausea.

The patient will see the doctor again after the surgery to make sure the tube remains in the eardrum and is working correctly. The surgeon may prescribe antibiotic ear drops to prevent infection in the ear. In addition, the surgeon may recommend that the child wear ear plugs during certain activities, such as swimming and showering.

The eardrum usually closes around the ear tube to keep it in place and prevent it from falling out early. The ear tubes will usually fall out in nine to 18 months. If the tubes do not fall out within two years, the surgeon may have to remove them.

What is an eardrum rupture?

An eardrum rupture is a small hole or tear in your eardrum, or tympanic membrane. The tympanic membraneis a thin tissue that divides your middle ear and outer ear canal.

This membrane vibrates when sound waves enter your ear. The vibration continues through the bones of the middle ear. Because this vibration allows you to hear, your hearing can suffer if your eardrum is damaged.

A ruptured eardrum is also called a perforated eardrum. In rare cases, this condition can cause permanent hearing loss.

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What is acoustic trauma?

Acoustic trauma is an injury to the inner ear that’s often caused by exposure to a high-decibel noise. This injury can occur after exposure to a single, very loud noise or from exposure to noises at significant decibels over a longer period of time.

Some injuries to the head can cause acoustic trauma if the eardrum is ruptured or if other injuries to the inner ear occur.

The eardrum protects the middle ear and inner ear. It also transmits signals to the brain by way of small vibrations.

Acoustic trauma can damage the way that these vibrations are handled, resulting in hearing loss. Sound moving into the inner ear can cause what doctors sometimes call a threshold shift, which can trigger hearing loss.

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