The Effects of Tympanostomy Tubes

What does research say about the impact of ear tubes on children?

Background: What are tympanostomy tubes?

The ear has three main parts that are all very important for hearing: the outer ear, the middle ear, and the inner ear. The outer ear is responsible for collecting sound and directing it to the middle ear. The middle ear takes these sounds and vibrations and transfers them to the inner ear, and the inner ear transforms those signals to send to the brain.

Occasionally fluid will build up in the middle ear causing hearing loss and occasionally ear infections. Fluid buildup in the middle ear is more formally known as otitis media with effusion (OME). Middle ear infections are more formally known as acute otitis media (AOM).

Fluid build up and infection are more in common in children than adults because children’s ears often have more difficulty draining fluid. This fluid reduces their hearing and can get infected. This why tympanostomy tube placement is the most common outpatient surgery performed on children in the United States. Tympanostomy tube placement involves placing a small tube in the eardrum in order to equalize pressure and prevent fluid buildup.

 

Research: What was studied?

A recent study looked at the effectiveness of tube placement in children with chronic OME and recurrent AOM compared to the “watch and wait” approach, in which no surgery is done. This study reviewed information from 147 different studies in order to develop of full picture of the results.

 

Results: What did the research find?

The review found that tympanostomy tube placement for children with chronic OME resulted in improved average hearing thresholds 1 to 3 months after surgery. The hearing threshold means the minimum level of sound the individual is able to hear. Children who had tubes placed improved their hearing thresholds by an average of 9.1 decibels. For scale, 20 decibels is similar to whispering or leaves rustling, while 60 decibels is the normal level for conversation. In children with recurrent AOM, tympanostomy tubes decreased the number of additional occurrences of AOM. In other words, the tube placement surgery worked to improve children’s hearing and decreased the number of additional ear infections they had in the following few months.

Despite these positive outcomes, studies found that the results were short term, and there was no lasting benefit. By 1 to 2 years after surgery, hearing thresholds were no longer different, usually because the tubes had fallen out. The study also did not find any consistent results regarding the relationship between tubes and improved cognition, behavior, or quality of life; however, more research is needed to firmly state this conclusion.

Negative side effects that occurred with tympanostomy tube placement were not always listed in the studies but included:

• Otorrhea: discharge from the ear
• Premature extrusion: tympanostomy tubes fall out earlier than intended
• Myringosclerosis: calcium deposits form on the ear drum
• Cholestatoma: abnormal skin growth in the middle ear
• Hearing loss

 

Take-Away: What does it mean for my child?

Despite the negative side effects and lack of clear long-term benefits from this study, we know how important hearing is for speech and language development. While the benefits of tympanostomy tubes might only last 1-3 months, those months could be vital for children as they learn language. A change in even 9.1 decibels could make a significant difference for children as they interact with their environment. A decrease in number of middle ear infections will also likely improve your child’s overall health and reduce the number of times you have to visit the doctor.

There are many factors to take into account when considering any type of surgery for your child, no matter which type. You should ask your audiologist for more information regarding the effects and risks of tympanostomy tube placement for your child.

 

 

Steele, D.W., Adam, G.P., Di, M., Halladay, C.H., Balk, E.M., Trikalinos, T.A. (2017). Effectiveness of tympanostomy tubes for otitis media: A meta-analysis. Pediatrics, 139 (6): e20170125.