Our younger daughter has add three sets of ear tubes in her life, the last set about 10 years ago. She is 19 now. She has been left with a permanent hole in her left eardrum. This winter she has suffered from middle ear blockage in her right ear. An ENT doctor she has recently seen recommends a tube for her right ear.
Q. Since she already has scar tissue on her right ear drum, does a tube make sense? Is it dangerous for her long-term hearing?
Q. How long should she hope or wish a new tube to stay in?
Q. Is it common for adults to have ear tubes? If so, what is the experience with them?
Q. Is there a better procedure or treatment for long-term health and prevention of fluid build-up in her middle ear.
Q. (final) If she should have an ear tube, should she get one as soon as practical or could (should) she wait until June when she will be home from College.
Many thanks for any answers or advice in advance.
Answer -------------------
Scarring of the ear drum (tympanosclerosis) is far more commonly associated with a past history of ear infections, than it is associated with prior ear surgery. Nevertheless, the misconception about risks of ear drum scarring after ear tube surgery is fairly widespread often fueled by incendiary commentary from biased publications in the lay press that are without adequate scientific basis.
Limited tympanosclerosis is a relatively common finding - more frequently seen in individuals who have not had surgical intervention. However, the presence of such tympanosclerosis is RARELY an important clinical finding. It is rarely associated with any degree of hearing loss. Even extensive tympanosclerosis involving the entire ear drum may have little affect on hearing. However, if tympanosclerosis extends to involve the ear bones (ossicles) inside the middle ear, then conductive hearing loss may be significant. It is important to understand however, that tympanosclerosis involving the ossicles is NOT a considered a potential complication of tympanostomy tubes.
The development of middle ear fluid is a common sequelae of an ear infection that in most cases will resolve after the infection is over. In some cases it may perisist for several weeks following the infection. If fluid persists beyond 2-3 months, the likelihood of resolution of fluid, either spontaneously or with the assistance of medication, becomes small. The presence of fluid is not necessarily an indication for continued antibiotic therapy. Usually the finding of fluid warrants a single course of antibiotics if one has not been previously administered in the past few weeks. If fever or severe pain is present, or if on physical examination pus is noted behind a bulging ear drum, then of course antibiotic therapy is warranted. Otherwise, simple observation is perfectly appropriate. The addition of adjunctive measures such as attempts at autoinflation (popping the ear drums), or the short term (3-5 days) use of topical nasal vasoconstrictive agents such as oxymetazoline (afrin spray) are often helpful. More recently the more long term use (several weeks) of daily topical nasal steroid has been found to be helpful in some patients.
Chronic middle ear fluid lasting several months usually is a sign of eustachian tube dysfunction whereby the normal ventilation and pressure equilibration of gases in the middle ear is disturbed. The gases are then absorbed and replaced with fluid. The fluid may provide nutrients for bacteria fostering their growth and result in acute infection. When fluid persists beyond 3 months, tube insertion is usually recommended. The placement of the tube eliminates the fluid and helps restore normal air pressure in the middle ear and normal function of the lining of the eustachian tube.
Chronic middle ear fluid left untreated may result in complications such as permanent hearing loss or more serious infections. Therefore, while it is not an urgent matter, the fluid can be observed for 3 months or even longer in certain circumstances, generally it wouldn't be considered wise to let it go for longer than 6 months.
Finally, placement of tympanostomy tubes, while most commonly performed in young children, is not an uncommon procedure in adults. In adults, however, it rarely requires general anesthesia. The placement of tympanostomy tubes in adults is considered an office procedure done with local anesthesia. A common method is to use a liquid topical anesthetic agent known as phenol that is applied to the surface of the ear drum with a small cotton swab under microscopic visualization. The procedure usually takes no more than 5 to 10 minutes. The most commonly used "bobbin" tubes generally will stay in place for 6 months to 1 year and extrude on their own.
As to prevention of recurrence of this problem in the future after it is corrected, elimination or control of all potentially causative factors must be addressed. Such factors may include allergy, nasal or sinus disease, adenoid disease, cigarette smoke, etc. Occasionally such discrete factors cannot be identified and in those patients the problem may simply be due to a chronic dysfunction of the eustachian tube.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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