It’s All in Your Head: Ear Ventilation Tubes

Today I thought I would talk about one of the most common procedures done by an ear nose and throat doctor, the insertion and placement of ventilating tubes in ears. In fact, it is the most commonly performed operation on children in the United States. I know that many of you either have children or grandchildren who have had ventilation tubes inserted to help relieve recurrent ear infections. And there are many questions about exactly what they are and why they are used. Additionally, they are not just placed in children as I have many adult patients who have them in one or both ears.

Many people have frequent difficulty in clearing their ears and getting them to open. Normally whenever we swallow or yawn muscles in the back of the throat temporarily pull open the ventilation system from the back of the nose to the ear, called the Eustachian Tube. It is something that naturally happens and we don’t even think about. But because of many factors such as allergy or infection the openings of the eustachian tubes in the back the nose swell shut and will not open reliably. This does happen more often in children than in adults because of the small size of the tube in kids.  When the Eustachian Tube will not open regularly the small amount of air that is normally behind each eardrum starts getting absorbed. This creates a vacuum which sucks in the eardrum, which is flexible, towards the center of the head. Often times this can be relieved at this point by having the person hold his nose and blow which pops the ears and relieves the pressure.

Unfortunately, especially in children, the ear will not pop open. This frequently leads to a buildup of fluid behind the eardrum which often is infected. The usual treatment here is antibiotics and maybe nasal sprays. But those measures are often not effective to cure the problem.  Since the late 1950s accepted treatment for this problem is the insertion of a very small button like piece of plastic or silicone in the center of the eardrum (called a tube because the first ones were made from tiny plastic tubing) to allow correct the problem.

Many people assume that the purpose of the ventilation tube is to let the fluid drain out. However, the real purpose is to provide an air vent from the outside world so that the fluid never accumulates at all.

Ventilation tubes are very safe with a low complication rate. In young children they are generally placed in the eardrum while under anesthesia.  I do have many adult patients who cannot clear their ears and they feel better with a vent tube. Most of those are inserted in the office in a painless procedure. The tubes are not permanent, and usually the ear drum healing process pushed them out in around 18 months. 

Not only do the ventilation tubes prevent infections but once placed in children it relieves the majority of their hearing problem. In fact, the most common reason for speech delay in children is repeated ear infections temporarily impairing hearing, so in these kids I highly recommend the procedure.