When is Ear Tube Surgery Performed?

In the surgery, a small incision is made in the eardrum to equalize the middle ear pressure with atmospheric pressure. After making a 2 mm incision in the eardrum under general anesthesia, the ear tube is placed onto the drum under a microscope. The surgery takes approximately 20–30 minutes.

In the vast majority of pediatric patients, adenoidectomy (removal of the adenoids) is also performed in the same session. This also helps open the Eustachian tube. Placing a ventilation tube in the eardrum will be beneficial for recurrent middle ear infections. After the surgery, the patient is monitored in the recovery room and discharged an hour later if no complications occur.

How is Ear Tube Surgery Performed?

Unless your doctor prefers a different method, the surgery is performed as follows:

1. Preparation and anesthesia: The patient is evaluated, an ear examination and, if necessary, an audiometry test are performed. General anesthesia is usually preferred for children, while short sedation or local anesthesia may be preferred for adults.
2. Visualization under the microscope: The ear canal is cleaned, and the eardrum is clearly visualized with the surgical microscope.
3. Myringotomy (small incision): An incision of approximately 1–2 mm is made in the anterior-inferior quadrant of the eardrum.
4. Fluid drainage: The serous/mucopurulent fluid accumulated in the middle ear is gently suctioned out with an aspirator. A sample of the fluid may be taken if necessary.
5. Tüpün yerleştirilmesi: A short-term “grommet” tube is placed at the edge of the incision, or a longer-lasting “T-tube” is placed under the microscope if the risk of recurrence is high. The tube provides ventilation between the middle ear and the external ear canal.
6. Application of drops: Antibiotic/anti-inflammatory ear drops are applied to reduce the risk of infection.
7. Post-surgery: The patient is discharged after observation. The tube is either spontaneously expelled after a determined period or is removed during a check-up.

Who should have ear tubes placed?

Ear tubes may be required for problems caused by prolonged fluid retention in the middle ear (such as hearing loss). Although this condition is usually seen in children, it can also occur in adults and causes hearing loss, balance problems, speech problems, and eardrum deformity.

Ear tubes may also be needed in conditions such as Eustachian tube blockage, eardrum deformation, Down Syndrome, and barotrauma (damage to the middle ear due to pressure change). Ear tubes are most commonly placed in children between the ages of 1 and 3.

Ear Tubes are Indicated When:

• There is continuous fluid in the middle ear lasting for four months,
• Fluid is present in both ears,
• The fluid in the middle ear is diagnosed as causing hearing loss based on hearing test results (hearing loss of more than 20 dB will seriously affect a child’s speech development),
• The fluid in the middle ear causes speech delay (For example, a child who has completed 18 months cannot speak at least three words, or a child who has completed two years cannot use twenty words),
• It is a solution to be used when recurrent ear infections and fluid buildup in the middle ear cannot be prevented despite the continuous application of antibiotics and appropriate treatments.

When and how should ear tubes be removed?

Under normal circumstances, it is generally sufficient for a tube to have functioned healthily for 9 months. After a period of approximately 12 months, the tubes are spontaneously expelled into the external ear canal. If the ear tube falls out earlier than expected, fluid accumulation in the middle ear may occur, and the tube may need to be surgically reinserted. If the tube falls out later than expected, it suggests the presence of an eardrum perforation that does not close spontaneously. The decision on when to remove ear tubes that do not fall out within the expected time will be made by an ENT specialist. In cases of recurrent illnesses and those requiring a second operation, tubes may be left in for many years.

What should be considered after surgery?

Patients have little to no pain after surgery. However, malaise, tenderness, and nausea may occasionally occur due to anesthesia. The hearing loss caused by the fluid accumulated in the middle ear is significantly eliminated after the surgery.

The ENT specialist prepares a special care and check-up plan for each patient and may request the use of antibiotics. The patient is advised to use earplugs while bathing, swimming in the sea, or in the pool after surgery. Otherwise, infection may occur as bacteria enter through the tubes along with water. However, recent research indicates that this risk of infection is high only in diving sports and when in contact with dirty water (lakes, ponds, etc.). Parents should consult an ENT specialist about what to be mindful of after the operation and guide their children accordingly.

What are the benefits of ear tube placement?

• It significantly reduces the risk of recurrence of middle ear infection.
• It eliminates hearing loss caused by fluid accumulated in the middle ear.
• It improves speech and balance, behavioral, and sleep problems resulting from middle ear infection.