Middle ear infections (otitis media) and persistent fluid in the middle ear are common problems in children. A child that develops recurrent ear infections or persistence of fluid in the middle ear is at risk for developing chronic middle ear problems including speech and language delays. The pediatrician will frequently refer the child to one of the ear, nose, and throat specialists within the Dallas ENT Group.
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Evaluation involves examination of the ear drum for the presence of fluid or infection, evaluation of the nasal airway, palate, and tonsils. Children that have cleft palates are at greater risk for developing recurrent ear infections and persistent fluid in the ear.
One of the surgeons with the Dallas ENT Group may recommend a preoperative hearing test prior to consideration of the surgical procedure.
The procedure is relatively quick, frequently less than 10 minutes, and anesthesia is performed by a pediatric-trained anesthesiologist. If vent tube placement is the only indicated procedure, then anesthesia is performed with a face mask for ventilation without placement of a tube into the trachea or wind pipe.
Under an operating microscope, a small incision is made through the ear drum. The fluid is suctioned from the middle ear, if present, and a small titanium (or silastic) tube is placed.
Your child will be taken to the pediatric recovery room for a short period of time. Parents are allowed in the post anesthesia care unit where recovery is very quick. Usually, your child will be discharged from the outpatient surgery unit within the hour.
You may expect a small amount of drainage from the ear for less than 24 hours. Antibiotic ear drops are prescribed at the time the child is scheduled and it is recommended that you place 3 drops in each year twice a day for 3 days.
Follow-up will occur within 3-4 weeks after the procedure. During that time, the surgeon will examine the ear for proper placement and a postoperative hearing test will be obtained. Interval follow-up will occur every 6 months to evaluate the functioning of the vent tube. During that time, drainage may occur through the vent tube. This is not uncommon, and in fact, studies indicate as many as 50% of children will drain through the tube usually at the time of an upper respiratory tract infection (common cold). The drainage is easily treated with irrigation and drops as detailed in the postoperative instructions on this link.
As follow-up continues on the 6-month basis, the vent tubes will extrude (come out of the eardrum) at 12-18 months. The majority of children (80%), will not experience further problems requiring replacement of vent tubes once they have extruded. The remaining 20% of children, however, will require the replacement of vent tubes for recurrent otitis media or persistent middle ear effusion. An adenoidectomy is usually recommended at the time of the second set of vent tubes to alleviate persistent obstruction of the eustachian tube.
Complications are very uncommon. As mentioned, drainage can occur and is easily controlled by irrigation, antibiotic drops, and occasionally oral antibiotics. 1% to 2% of children develop a small persistent hole after the vent tube comes out. This small perforation can be repaired easily with a tissue graft.
The surgeons with the Dallas ENT Group are accessible when those problems occur with persistent drainage that does not clear easily with the irrigation and ear drops.