Painful ear infections are a rite of passage for children – by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own or are effectively treated with antibiotics. But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior, and speech problems. In these cases, insertion of an ear tube by an ear, nose, and throat physician may be considered.
 
What Are Ear tubes?

Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes.  
 
Who Needs Ear Tubes?

Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or Eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure), usually seen with altitude changes such as flying and scuba diving.  
 
Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia.  The average age of ear tube insertion is one to three years old. Inserting ear tubes may:
• reduce the risk of future ear infection,
• restore hearing loss caused by middle ear fluid,
• improve speech problems and balance problems, and
• improve behavior and sleep problems caused by chronic ear infections.
 
How Are Ear Tubes Inserted?

Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife), but it can also be accomplished with a laser.  If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (for ventilation).
 
Ear Tube Surgery 

A light general anesthetic is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly.


Possible Complications

Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:

• Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.

• Scarring – Any irritation of the ear drum, including repeated insertion of ear tubes, can cause scarring. In most cases, this causes no problems with hearing.

• Infection – Ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops. Sometimes an oral antibiotic is still needed.

• Ear Tubes Come Out Too Early Or Stay In Too Long – If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by the otolaryngologist.

One of the key components in a physician’s decision to place ear tubes is the presence and degree of hearing loss. Hearing loss can be detected accurately in young children by a Pediatric Audiologist.

Dr. Shirley Pollak has been serving the Brooklyn community in clinical practice for 18 years and leads a team of highly competent and professional audiologists providing quality care and service and the highest level of hearing instrument technology. Their knowledge and expertise combined with the latest hearing health care breakthroughs, computerization, ultramodern techniques, and state-of-the-art systems – allows them to offer accurate and successful hearing technology fittings exactly tailored to the individual needs of each patient. She also does newborn hearing screening and can be reached at: Pollak Audiological 718-474-4744 and Rockaway Audiology and Hearing Aid Center: 718-421-2782.
www.brooklynlearning.com

Hearing challenges present themselves in different ways, especially with regards to children and adults. C’mon, we all remember the frustration we felt when asked to repeat ourselves to our grandparent or neighbor once again (for the fourth time!!!)…but what about that baby who is seemingly so content and happy but also quiet because he misses half of what is being said around him….or what about the child who does not laugh at his friend’s joke because although he heard what was said, he did not hear the subtle cues in the spoken phrase. How about the child who has difficulty picking up a second language or who has to work extra hard in school to follow directions in his first language? Did you stop to think it may be resulting from a hearing loss? Did it ever occur to you that he may be hearing at different levels every day or week because of a fluctuating hearing loss due to fluid buildup in his ears?
Parents do not run to specialists for a diagnosis; they want to hear that their child is ok…but when there is a problem, they are often thankful that it was caught early so that treatment can begin in a timely manner. It is important to understand that we, audiologists, are also here to rule out hearing loss in your child. We do not want to give our patients a diagnosis; however, when we are in the unfortunate situation that we find a problem, we are here to help you accept it so that you can move on to the next step of treatment. Whether the problem is a temporary one involving medical treatment, or a more permanent one involving hearing aids or aural (re)habilitation, we are here to hold your hands and walk through this with you but most importantly of all, to make it easier for your child to hear and enjoy living in this beautiful and yes- noisy – world of ours.
It is important that parents understand what audiologists do so that they will know when audiological testing is in order. Audiologists are hearing healthcare professionals who specialize in the diagnosis, treatment and monitoring of auditory and vestibular (balance) disorders in patients of all ages. Some audiologists specialize in the pediatric or geriatric population but many work with both age groups. Starting from the newborn period, audiologists are involved in the newborn hearing screening programs. Hearing loss is among the most common birth defect, affecting approximately 4-6 babies out of every thousand born. Currently, a majority of states mandate that hospitals and birthing centers screen infants for hearing loss before they are discharged. In New York, hospitals with over four hundred births per year must screen for hearing loss. Previously, the average age of identification of congenital hearing loss occurred at approximately 2 ½ to 3 years, well past the age of initial language development resulting in significant speech and language delays, learning deficits, or even behavior problems that could have been avoided if the hearing loss was identified early. The purpose of the newborn hearing screening program is to identify a child with hearing loss by the time they reach three months of age. According to the National Center for Hearing Assessment and Management (NCHAM) detecting and treating one child with hearing loss at birth saves $400,000 in special education costs by the time that child graduates from high school.
Audiologists are also involved in the Early Intervention process as a child is being evaluated for appropriate services. An audiological evaluation is often recommended for a child who is undergoing these evaluations through the Early Intervention Program to rule out hearing loss as a contributing factor to the suspected delay. As mentioned above, it is important to understand that the effects of hearing loss on a young child do not only include a speech and language delay. Especially if the hearing loss is of a mild or mild to moderate degree, effects can include social or behavioral problems or attention and focusing issues. The effects of hearing loss vary from child to child and can be manifested in many different ways. Even if you, the mother, feel that your child hears perfectly well, it is important to follow up with audiological evaluations to rule out mild, minimal or even unilateral hearing losses. Knowledge about your child’s hearing status will only help and never hurt in the long run.
Audiologists also test pre-school, elementary or high school aged children if medically indicated, if a child does not pass a hearing screening or if a child is struggling in school. We must remember that hearing can change over time, either due to a medical and treatable condition or due to a permanent progressive condition. It is always better to be in the know so that if a problem is identified, early intervention can help to offset some of the negative effects.

Dr. Shirley Pollak has been serving the Brooklyn community in clinical practice for 18 years and leads a team of highly competent and professional audiologists providing quality care and service and the highest level of hearing instrument technology. Their knowledge and expertise combined with the latest hearing health care breakthroughs, computerization, ultramodern techniques, and state-of-the-art systems – allows them to offer accurate and successful hearing technology fittings exactly tailored to the individual needs of each patient. She also does newborn hearing screening and can be reached at: Pollak Audiological 718-474-4744 and Rockaway Audiology and Hearing Aid Center: 718-421-2782. www.brooklynlearning.com