Question: My daughter is 6 years old and suffers from eustachian tube blockage (dysfunction). She has chronic fluid in her middle ear. She had a third ventilation tube put in her left ear in June 2012, and that ear is doing fine. Her right ear had a fungal infection which caused its second ventilation tube to fall out and created a perforation that lasted for nearly a year. The doctor thought it would not heal on its own, however, in December 2012 the perforation had closed.
The right ear now has a retracted eardrum. It is not a pocket, but rather the entire eardrum is retracted. The recommendation is to place a ventilation tube in that right ear and also remove the adenoid. I’d like to know if the retraction should be corrected with a vent tube or if this will cause an increase in the possible recurrence of the retraction. What is a safe amount of time that we can monitor a retraction if we choose to observe, rather than surgery?
Also, have any studies been done that can conclusively say that removing the adenoid will decrease the middle ear fluid? I would love to read current studies and recommendations for children with middle ear fluid.
Thank you!
Answer:
Thanks for your question. Unfortunately, your daughter has had a lot of trouble with her ears, but the good news is that she and you should get through this fine.
We place ventilation tubes through the eardrum to drain the middle ear in children (and adults) whose own normal drainage through their eustachian tubes is not working well. In these people, fluid builds up behind the eardrum and can cause infection and hearing loss. Only if the fluid fails to drain, do we recommend drainage tubes. They tend to stay in about 6 months, and then come out on their own. You usually don’t feel the tubes, or when they come out, but they should help in terms of middle ear infection and bringing back any hearing loss caused by the fluid. Putting in tubes doesn’t really get to the cause of the eustachian tube blockage (dysfunction) but usually allows time for your child to “grow out” of the problem.
Studies by Maw in England showed that if children needed a second set of tubes, an adenoidectomy if done at that second time, would lessen the need for a third set of tubes by almost 50 %.
Paradise in Pittsburgh showed that if an adenoidectomy were done at that second set of tubes, children spent 47% less time with fluid the first year after and 37% less time with fluid the next.
Usually, one would suggest doing an adenoidectomy should your daughter need tubes again. We do recommend putting tubes in for eardrums that are getting “retracted” or sucked back. The hope is that the tubes allow air to get into the middle ear space and push the eardrum back to its normal position. Once an eardrum is scarred in a retracted position, there may be a persistent hearing loss. I don’t know of any study saying how long one can observe a retraction, as I believe the development of scarring in that position is quite variable. I would discuss this with your doctor.
The good news though is that she is already 6, and most children are aging out of the problem about this age. There always is a possibility that this will resolve without further intervention, but it is hard to predict.
Robert Pincus MD
NY Otolaryngology Group
Frequently Asked Questions
Ventilation tubes are placed through the eardrum to drain fluid from the middle ear in children whose natural eustachian tube drainage is not functioning well. They help reduce middle ear infections and associated hearing loss by allowing air to enter and fluid to drain, usually staying in place for about six months before falling out on their own.
Adenoidectomy is often recommended during a second insertion of ventilation tubes because studies show it reduces the need for additional tubes and decreases the time children spend with middle ear fluid. Research indicates that removing the adenoids can lessen the recurrence of fluid buildup and support better ear health in children requiring multiple sets of tubes.
Yes, ventilation tubes can help correct a retracted eardrum by allowing air into the middle ear space, which pushes the eardrum back to its normal position. However, if the eardrum has been scarred in the retracted position, there may be persistent hearing loss, so timely treatment is important.
There is no definitive study specifying a safe observation period for eardrum retraction, as the development of scarring varies among individuals. It is best to discuss the appropriate monitoring timeframe with the child's doctor, considering the severity and progression of the retraction.
No, ventilation tubes do not cure the underlying eustachian tube dysfunction. Instead, they provide a temporary solution by allowing fluid to drain and air to enter the middle ear, giving the child time to naturally outgrow the problem as they develop.
Most children tend to outgrow eustachian tube dysfunction by around six years of age, with improvements in middle ear drainage and reduction of fluid buildup. While individual outcomes vary, aging often reduces the severity and frequency of these ear problems.
Yes, studies by Maw and Paradise demonstrated that adenoidectomy during the insertion of a second set of ventilation tubes reduces the likelihood of needing additional tubes and significantly decreases the time children have middle ear fluid during the first and subsequent years after surgery.
