What makes up the ear and how does it work?

  • The ear is made up of an outer ear, middle ear, and inner ear.
  • The part we can see is the outer ear and includes the ear canal. It captures sound energy and sends it to the ear drum.
  • The middle ear is an air pocket underneath the ear drum and contains three hearing bones.
  • Sound waves hitting the ear drum create vibrations that are transmitted down the hearing bones to the inner ear (cochlea).
    • The cochlea is a fluid-filled structure with sensory cells called hair cells.
    • The hair cells translate the vibrations into patterns of stimulation for the auditory nerve.
    • The auditory nerve then takes this information to the brain. In this way, the inner ear changes the sound vibrations into signals the brain understands.

Why are children at risk for chronic ear infections?

Young children experience more ear infections than adults because the Eustachian tube is not fully developed. The Eustachian tube connects the ear to the back of the nose and is what “pops” when you yawn, sneeze, fly, etc.

Ear infections also create thick fluid under the eardrum. This causes “muffled hearing” and sets the stage for further infections.  Antibiotics may clear the infection but may not resolve the fluid trapped under the eardrum.  This is why some children have chronic ear infections despite numerous rounds of antibiotics.

What are tympanostomy tubes, and how do they work?

Ear tubes (i.e. tympanostomy tubes or myringotomy tubes) are small pieces of plastic or metal that are placed through the eardrum to ventilate the space underneath.  These tubes prevent fluid from building up under the eardrum and provide better long-term control of ear infections than antibiotics alone.

Tubes are placed for frequent and persistent ear infections that do not respond to antibiotics.  The risk of ear infections drops significantly after tympanostomy tubes are placed.  Persistent fluid in the ear that muffles hearing or causes speech delay in children is also effectively treated with tympanostomy tubes.

Tympanostomy tubes last 1-2 years and then fall out on their own.  Children typically do not feel the tubes while they are in place and cannot reach them.

Will my child experience ear drainage with tubes?

Ear drainage with tubes is uncommon, and its appearance usually means an ear infection is present. Pain, fever, and irritability are usually not seen with ear infections with tympanostomy tubes.  Antibiotic ear drops are often all that is required to control ear drainage.

How involved is having tympanostomy tubes placed?

Placing tympanostomy tubes is done in the operating room and takes about 5 minutes of anesthesia (usually with only a mask).  Most children are ready to go home 15 minutes after the procedure is complete and are normal by the end of the day.  While activity is not restricted after tympanostomy tube placement, ear plugs are recommended with exposure to untreated water (lake, river, ocean, etc.).

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