Ventilation Tube Insertion

Ventilation tube insertion is one of the most basic and simplest procedures performed by ear surgeons. This is usually performed to remove a chronic middle ear effusion (fluid) which has not resolved with medical therapy, or to prevent recurrent acute infections or symptoms of Eustachian tube dysfunction. In adults and older children, it can be performed under local anesthesia in the office and takes just a few minutes. Babies and children are brought to the operating room for this short procedure.

In the office, the eardrum is numbed with a drop of medication or a needle injection which stings for a few seconds and renders the rest of the procedure painless. Babies and children are given a sedative before bringing them into the operating room for anesthesia.

The surgery is performed through the ear canal using a microscope or endoscope. An incision is made in the eardrum, the fluid or pus is suctioned from the middle ear and a ventilation tube is placed into the hole. Antibiotic ear drops are prescribed for a few days to a week after the procedure, and oral antibiotics are sometimes prescribed depending on the type and amount of fluid in the ear at the time of surgery.

Ventilation Tube Insertion Images

Post-op care 

Babies and young children go home in 30-60 minutes after awakening from anesthesia. Tylenol is used for discomfort. They may return to daycare the same afternoon. Adults may return to their normal daily schedule immediately after leaving the office.

It is usually recommended to use earplugs to keep water out of the ear during baths, showers and swimming to prevent infection, although this is controversial and may not be needed in some people.

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 and some patients require long-acting tubes. In these cases, the eardrum is sometimes reinforced with cartilage or a tissue graft to give it more strength so the tube will last longer. The ear canal bone is sometimes widened.

Possible complications

  • Scarring of the ear drum: this is usually minor and rarely is a health concern.
  • Weakening of the ear drum: repeated surgery can weaken the ear drum.
  • A hole in the eardrum: a perforation of the eardrum may occur in 1-2% of ears. This can usually be repaired with a patch or a tympanoplasty.
  • Chronic drainage of fluid: This is rare and usually occurs when there is chronic infection or allergies present.
  • Early extrusion or blockage of the tubes and repeat ear infections.
  • Cholesteatoma formation: this is a rare condition that can occur if skin from the ear drum migrates through a hole and in to the middle ear.