Middle ear tube surgery

An ENT specialist qualifies for ear tube surgery. During the qualifying visit, the doctor will take a history, perform a general ENT examination, as well as an endoscopic examination of the nasopharynx and tympanometry (middle ear pressure test). Tests performed earlier may be helpful, please bring them with you. The middle ear is connected to the nasopharynx by means of the Eustachian tube, through which air enters the tympanic cavity. Exudative otitis media is a condition caused by a dysfunction of the Eustachian tube and involves buildup of thick effusion in the tympanic cavity. Exudative otitis media usually occurs in children with adenoid hypertrophy due to blockage of the pharyngeal outlet of the Eustachian tube by hypertrophied lymphoid tissue of the tonsil.

Another cause may also be reflux disease, in which there is swelling of the mucosa due to reduced pH. In adults, Eustachian tube disorders leading to exudative otitis media may be associated with lesions at the base of the skull, occur secondary to radiation therapy, or co-occur with autoimmune diseases (such as granulomatosis with polyangiitis). In exudative otitis media, there is reversible conductive hearing loss. Untreated exudative inflammation leads to the formation of retraction pockets of the tympanic membrane and is the starting point for cholesteatoma.

The procedure for inserting a middle ear tube in children is carried out under general anaesthesia, in adults the procedure can be performed under local anaesthesia. In children, together with the ear tube insertion, an adenotomy is generally performed to unblock the pharyngeal outlet of the Eustachian tube. The ear tube surgery involves making an incision in the tympanic membrane and suctioning out the thick effusion accumulated in the tympanic cavity. Since the tympanic membrane heals very quickly (a few days), while the Eustachian tube requires a longer time to restore its function, it is necessary to insert a tube. Ear tubes are inserted for a period of 6-9 months. After this period, the tube falls out of the tympanic membrane on its own. Permanent T tubes are used when the return to the Eustachian tube function takes a long time or is uncertain.

Hearing improvement occurs immediately after the procedure. The patient is usually discharged home on the day of the procedure. ENT follow-up is recommended on the first day after surgery.

Preoperative instructions:

• Full blood count
• Coagulation pathway (APTT)
• Blood type
• Do not vaccinate the child for 2 weeks before the surgery
• The surgery is not performed if acute infection is found, while chronic rhinitis is not a contraindication to surgery

Postoperative instructions:

• Keep the ear dry until the tube falls out
• Check the position of the drain in the tympanic membrane every few months