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.
Putting PE tubes in your child’s ears will not keep them from having ear infections. The tubes allow the infection to drain out of the ear or to the back of the throat. After the tubes are placed, infections can be treated more efficiently using antibiotic ear drops rather than antibiotics by mouth. Preventing fluid from staying in the middle ear can help to restore and preserve normal hearing.
During Surgery
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.
If fluid or infection is present in the middle ear, it is suctioned out and the tube is placed into the incision.
Surgery After-Care
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 them acetaminophen (Tylenol) or ibuprofen (Advil or Motrin).
Some children experience nausea and vomiting from the general anesthetic. This should go away 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.
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, non-chlorinated water and excessively soapy or dirty bathtub water. When washing your child’s hair, rinse with fresh water from the tap (shower or spray nozzle). Dirty water should be avoided, or children should wear ear putty or ear plugs when exposed to dirty water. Ear putty or ear plugs are available at most major pharmacies. 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 or salt water pools. If the ears are submerged in the bathtub, ear plugs should be worn.
Drainage
Since an opening into the middle ear has been created, any drainage (other than wax) from the ear indicates an ear infection. 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 treat the infection. Some children may have difficulty tolerating the ear drops. If this occurs, contact your ENT provider.
Possible Experiences After Surgery
Hearing
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. For infants that seem fussy, a quiet environment for the first 24 hours may be helpful.
Ear Infections
Children with tubes will usually have drainage from the ear with an infection. If your child develops ear drainage, use the drops as directed and notify your ENT provider.
If your child is experiencing discomfort, over the counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be given.
Rejection of the Tubes
Because the PE tube is a foreign material to the body, the tube will usually be rejected or pushed out of the eardrum naturally by the body. Depending on the type of tube, this will most often occur 6 to 18 months after the tubes have been placed.
Most children will not need a second set of PE tubes.
Follow-Up
A follow-up 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, your ENT provider will check the status of the PE tubes and evaluate the condition of the eardrum.
