My daughter is nine years old. She has had chronic "silent" ear infections since infancy. When she was 2 her ear drum perforated. Since that time she has had two sets of tubes. The after the second set fell out, the performation in her left ear took over a year to heal. It has healed and perforated several times since then, (Usually perforating healed in less than a month). She recently underwent a myringoplasty to stimulate the healing. The doctor indicated that the tissue of her eardrum was extremely thin at the point of the rupture, and that the myringoplasty would help in thickening that area. After two months the ear hadn't healed so on May 7, my daughter underwent tympanoplasty, replacing the eardrum with fascia removed from a temporal muscle. We were told that this tissue was roughly 4 times thicker than the natural eardrum and that it was highly unlikely that she would experience future perforations. Two weeks ago, she began complaining of drainage. We immediately had her seen. She was placed on anti-biotics. After the infection cleared she was seen to be sure we caught it on time. There was no perforation, but slight inflamation. She was given drops to reduce the inflamation. One week later, we took her for her surgical follow-up, and learned that the ear-drum had once again perforated.
I was wondering if there are any surgical procedures which can repair dysfucntional eustacian tubes. Can problems with the tubes be diagnosed by MRI or CATSCAN or other modern testing equipment? Are there stents or other devices which can be used to help the tubes to function?
Thank you.
Reply --------------------
It is quite probable that eustachian tube dysfunction plays a large role in the frequency of ear problems your daughter has endured. It is possible that at least a part of the problem might be developmental in nature and therefore might improve with age. However, at 9 years of age, the eustachian tube anatomy has probably reached reasonable maturity and developmentally related problems most likely contribute at most only a small amount to the overall problem. In your post, there is no mention of your daughter having had an adenoidectomy. If this has not been done, it certainly should be considered. There is more than ample support in the medical literature for adenoidectomy in the management of chronic ear infection regardless of the size of the adenoid tissue. One potential mechanism for chronic ear infection is chronic bacterial colonization of the adenoid tissue with subsequent reflux up the eustachian tubes. Ablation of the adenoid tissue eliminates the bacterial reservoir. In contrast, there is little evidence for any relationship between the ears and the tonsils, and therefore no justification for tonsil removal. Allergy should also be investigated if it hasn't been done. Second hand cigarette smoke exposure should be eliminated if any exists. To specifically answer your question regarding direct surgical measures on the eustachian tubes, there are none currently that can provide a benefit and direct surgical manipulation of the eustachian tubes can lead to permanent scarring. Surgical measures designed to assist in the restoration of normal eustachian tube function are basically indirect in nature - tympanostomy tubes to ventilate the middle ear and adenoidectomy to remove bacterial reservoirs or actual anatomic blockage of the eustachian tubes.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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