How is a Pressure Equalizing (PE) Tube Inserted?
Ear tubes are known by several names: tympanostomy tubes, ventilating tubes, pressure equalizing tubes, or most frequently, PE tubes. They are tiny hollow tubes made of a soft material.
PE tubes decrease the frequency of ear infections by allowing air in and helping fluid to drain into the throat. Preventing fluid from staying in the middle ear can help to restore and preserve normal hearing. The small tubes that are used do not cause hearing loss or long-term damage to the eardrum.
PE tubes are inserted under general anesthesia as an outpatient surgery. A microscope is used to see into the ear and a small incision is made in the eardrum.
Any fluid or infection present in the middle ear is suctioned and the tube is placed into the incision where it remains without the use of stitches.
Most children are back to normal within a few hours of surgery. Generally, children do not have any post-operative pain. If your child is fussy or runs a fever, give acetaminophen (Tylenol) or ibuprofen (Advil or Motrin).
Some children experience nausea and vomiting from the general anesthetic. This should resolve within a few hours. Begin with a clear liquid diet, progress to a light diet, and then to a normal diet as your child feels like eating. Please call the office nurse if nausea and vomiting continues for more than 12 to 24 hours.
Protection from Water
After PE tubes are inserted, prevent dirty water from entering the ear canals. Dirty water can carry bacteria into the middle ear through the tube and cause an ear infection.
Dirty water includes lake, river, ocean and non-chlorinated water and excessively soapy or dirty bathtub water. Dirty water should be avoided or children should wear silicone ear putty or Proplugs when exposed to dirty water. These should be placed in the outer ear to block the ear canal, but not directly into the canal itself.
There is generally no need for ear protection for bathing, showering, or swimming in chlorinated water. When bathing, hair should be rinsed with fresh water from the tap. If the head is completely submerged in the bathtub, ear plugs should be worn.
In specific cases, different instructions may be given. Proplugs are available at all office locations. Silicone ear putty is available at most major pharmacies.
Since an opening into the middle ear has been created, there may be drainage of fluid. The drainage may be clear, yellow, orange, green, brown, pink or bloody. There may be a small amount of crusty drainage, drainage in the ear canal, or drainage dripping from the ear.
Ear drops may be given to use after surgery. In some children, these drops cause a burning sensation. Stop the drops if your child is unable to tolerate them.
Possible Experiences after Surgery
Many children experience an immediate improvement in hearing after the fluid is removed from the middle ear and PE tubes have been inserted. This may cause the child to be frightened by normal sounds because they will seem loud. Children usually adjust quickly to these louder sounds.
PE tubes will prevent ear infections from developing most of the time. However, some children with tubes develop an ear infection despite the tubes.
Children with tubes will usually have drainage from the ear with an infection. The drainage may be clear, yellow, orange, green, brown, pink, or bloody. Your doctor will give you a prescription for ear drops to keep on hand. If your child develops ear drainage, use the drops as directed and notify our office the next business day, so that we may update our records.
If needed, pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be given. If you do not have a prescription or have run out of drops, call the office nurse during normal office hours (Monday through Friday 9 to 5) for a prescription.
Over the weekends and on holidays, the doctor on call can be reached through the hospital operator from 9 to 5. Please call the office nurse if the ear drainage does not resolve in 7 days, or if there is significant pain or any swelling of the ear or ear canal.
Rejection of the Tubes
Because the PE tube is a foreign material to the body, the tube will eventually be rejected or pushed out of the eardrum. Depending on the type of tube, this will most often occur six to 12 months after the tubes have been placed.
Most children will not need a second set of PE tubes. Usually by the time the tubes have fallen out, the child has outgrown the need for tubes. Approximately 15 percent of children will need another set of tubes to be inserted.
A postoperative office appointment is needed after surgery and then periodically until the PE tubes are out or until your child no longer has problems with ear infections.
During these visits we will check the status of the PE tubes and evaluate the condition of the eardrum. If there are problems or questions, call the office nurse.
Most ear problems can be dealt with during our normal office hours. If you feel you are unable to wait, contact Cincinnati Children's, 513-636-4200, and ask for the ENT resident on call.