PDF Download: Postoperative Instructions Ear Tube Surgery
Bilateral Myringotomy and Tympanostomy Tube (BMT) Placement
Ear tube surgery involves making a small incision in the eardrum, removing middle ear fluid, and inserting a small plastic tube. The short surgical procedure (10-20 min) is performed under a light general anesthetic. Surgically, it is referred to as a BMT (bilateral myringotomy and tympanostomy tube) placement which keeps the hole open and allows middle ear ventilation, drainage, and pressure equalization.
While children of all ages may require ear tubes for chronic ear infections, the most common ages of kids receiving tubes are between 10-18 months of age. The tubes typically last between 6 months and 18 months but they can extrude earlier or stay in longer. If an ear tube does not come out of the eardrum in 3 years, then they will need to be surgically removed and the hole patched. Ear tube surgery is the most common surgery performed in children in the United States.
Ear Infection
The primary reasons for a child to receive ear tubes are for recurrent ear infections or persistent fluid behind the eardrum leading to hearing loss and subsequent speech delay.
The reason why children get ear infections or retain middle ear fluid requiring tubes, is because of eustachian tube dysfunction. The eustachian tube is a tube that goes from your middle ear to the back of your nose (nasopharynx). It is responsible for equalizing air pressure in your middle ear by opening and closing. When it doesn’t work properly a vacuum with negative pressure can be formed and fluid can be drawn up to the middle ear thus yielding an ear infection. Placing an ear tube in the eardrum allows air to go in and out of the middle ear from the side of the ear canal. For this reason, the tubes are also called “pressure equalization” tubes.
Eustachian tube dysfunction is very common in infants and toddlers because their eustachian tubes are immature and are under developed. The eustachian tube tends to mature by age five which is why ear infections are less common after this age. Children that have syndromes or neuromuscular disorders, such as Down’s Syndrome, leading to low muscle tone also tend to have chronic eustachian tube dysfunction and almost always require ear tubes at a young age. Additionally, infants born with a cleft palate have chronic eustachian tube dysfunction because the eustachian tube attaches to a weakened palate.
There are many types of ear tubes. They can be grouped into two categories: short-acting tubes and long-acting tubes. Short acting tubes are designed to stay in 6 months to a year and a half before they often extrude on their own. These are the tubes placed in infants and toddlers. Examples of these tubes are Armstrong grommets, type 1 Paparella tubes, Reuter-Bobbin tubes. These tubes are about 1.5 mm long. The type of tube placed is usually surgeon preference. Long-acting tubes, or “t-tubes” are designed to stay in place for at least 3 years. They are indicated in children or adults that have had at least 3 sets of short-acting tubes and still have eustachian tube dysfunction requiring a tube. They often need to be surgically removed and can leave a larger hole. Examples of t-tubes are Goode t-tubes, Richards modified t-tubes, and U-tubes.
Dr. Baktha Ear Tube Surgery Postoperative Instructions
Place antibiotic ear drops that you have been prescribed for a minimum of 3 days in each ear. If there is any persistent drainage you can continue the drops for a total of 7 days maximum. If any drainage persists past 7 days, stop the drops and contact Dr. Baktha’s office for an appointment.
Try to keep the ears dry for 24 hours. Afterwards, bath water and pool water exposure require no protection. Dr. Baktha recommends using ear plugs for the duration of the tubes if the head is submerged in untreated water (i.e. beach water, lake water).
Make a post-op appointment for 4-6 weeks after surgery for an ear tube check and hearing test. If you have any concerns prior to that please call the office to schedule an appointment.
Sometimes the tubes can be plugged with mucous or dried blood especially after surgery if the ears were infected on the day of surgery. If the tubes are plugged at the post-op visit you may given instructions to use dilute hydrogen peroxide drops in the ears to dissolve the plug for a few weeks before returning to clinic. Depending on the situation, Dr. Baktha may try to unplug the tubes in the office or wait until a round of hydrogen peroxide drops have been used and attempt to unplug them at the next visit.
If you ever see any drainage from your child’s ear you can start the antibiotic eardrops on your own for up to 7 days. Any drainage that lasts past that be sure to call our office.
Dr. Baktha Ear Tube Removal Postoperative Instructions
After surgery, your child may experience some soreness in the ears requiring Tylenol or Advil/Motrin. Keep the ears dry for 4 weeks or until your first post-op appointment. Dr. Baktha recommends using a cotton ball with Vaseline on it as an earplug while bathing or showering. Try to refrain from swimming underwater during this recovery period.
There will be ointment in the ears so your child’s hearing may feel muffled until the ointment dissolves which could take several weeks. No antibiotic drops are needed.
Make a post-op appointment for 4 weeks after surgery.