Ventilation Tube Insertion

Ventilation tube insertion is one of the most basic and simplest procedures performed by ear surgeons. In adults and older children, it can be performed under local anesthesia in the office. Babies and children require it to be performed in the operating room during a procedure that takes 5-10 minutes.

In the office, the ear drum is numbed with a drop of medication which stings slightly for a few seconds and renders the rest of the procedure painless.

In the hospital or surgery center, children are given a liquid to drink to relax them and they are brought into the operating room. A mask is placed over the face and gas is usually used to sedate/anesthetize the child.

The surgery involves using a microscope and working through the ear canal. An incision is made in the ear drum with a tiny knife. The fluid or infection in the middle ear is suctioned out and a ventilation tube is placed into the hole. Antibiotic drops are placed in the ear canal. The child is then brought to the recovery room. Antibiotic ear drops are sometimes prescribed for a few days to a week after the procedure, depending on the type and amount of fluid in the ear at the time of surgery.

Post-op care involves keeping water out of the ear during baths, showers and swimming using ear plugs.

The tubes stay in the eardrum and gradually work their way out and fall into the ear canal over a period of time depending on the size and type of tube used and the speed of growth of the skin of the eardrum. Most children have intermediate length tubes put in designed to last 1-2 years, but this is highly variable. Tubes sometimes fall out early, or get stuck and have to be removed if they haven’t come out after 2-3 years.

After the tubes have fallen out, the child is observed to ensure they have grown out of ear infections. Some children require tube insertion more than once. Most children have outgrown the problem by 6 or 7 years of age. The problems can persist into adulthood. Some adults need long-acting tubes and this can require placement in the operating room.

Flouroplastic ventilation tube	Titanium ventilation tube through reconstructed ear drum

Possible complications include:

• Scarring of the ear drum: this is usually minor and rarely is a health concern
  
• Weakening of the ear drum: surgery can weaken the ear drum and cause the ear drum to collapse in to the ear. This occurs mosre frequently in ears that do not have tubes inserted when there are Eustachian tube problems.
  
• A hole in the eardrum: a perforation of the eardrum which varies in frequency with the size and type of tube used. On average, about 1-2% of ears will have a hole after the tube has fallen out that does not close on its own. A tympanoplasty is then sometimes
  
• Chronic drainage of fluid from the ears from chronic infection. This is rare and usually occurs when water is allowed to get in to the tubes
  
• Early extrusion or blockage of the tubes and repeat ear infections
  
• The tube can get stuck in the ear and require another short procedure to remove it
  
• Cholesteatoma formation: this is a rare condition that can occur is skin from the ear drum migrates through a hole and in to the middle ear

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