I have a 16yr old son who at the age of 8 started having middle ear fluid causing temporary hearing loss, since then he has tried every decongestant, antihistamine, and several antibiotics there are, adnoids have been removed and placement of pe tubes 6 times, currently he has 1 blocked tube, the tube in the other ear came out 1 month ago and is now filled with fluid....so now his hearing is compromised..end results are failure in school due to missing info. My concern how many surgeries before damage is done, is this a common recurrence, what other methods can we try........my son is extremly frustrated and refuses any more surgical interventions....any help you can offer will be appreciated.........thank you.
Reply: ----------------------------------
Unfortunately, there are individuals who have chronic ear problems in childhood and continue to have the same problems through adolescence and into adulthood. For these individuals, the problem is usually chronic eustachian tube dysfunction. There are many theories as to why this might occur - allergy, immune dysfunction, palatal muscle abnormalities, obstruction of the eustachian tube, problems with the function of the mucous membrane lining the eustachian tube, etc. Furthermore causes might be related to hereditary or environmental factors. The medical histories of these patients is often quite similar - they have had frequent ear infections as a child, had several sets of tubes, had their adenoids removed, had allergy evaluations, etc. Despite all of this, they continue to remain somewhat dependent on tympanostomy tubes to prevent retraction of the ear drums and fluid accumulation. The tympanic membrane retraction and fluid accumulation causes hearing loss initially due to simply mass effect from the fluid. Chronic retraction and fluid eventually can lead to more significant problems such as erosion of the small bones that conduct sound waves to the inner ear, holes in the ear drum, or cysts that cause destruction in the ear (cholesteatoma). Repeated tube insertion may be the only available measure that can prevent further permanent injury to the ear in these patients due to the chronic eustachian tube problem. Control of environmental factors such as avoidance of cigarette smoke and allergy control is important. Adenoidectomy in children over 4 years of age has been shown to be effective in many patients - this is thought to remove a potential reservoir of bacteria which may be refluxing up the eustachian tube into the ear. When all of these measures have been done, continued tympanostomy tube placement may be the only treatment available to prevent more serious problems. Yes there may be some damage to the ear drum caused by repeated tympanostomy tube placement and this must be weighed against the risk of probable permanent damage to the ear from the disease process itself. In this situation, long term ventilating tubes are generally recommended such as T-tubes. There is also a more permanent type of tube available which is made of hydroxyl-appatite that is placed in a small notch created in the bone where the ear drum is attached - this then can eliminate the need for repeated tube insertion.
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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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