Ventilation Tube

A 6-year-old male presents to the pediatric clinic for a well-child visit. The parents have no concerns for today’s visit. They note that he has a history of recurrent ear infections and had “ear tubes” placed 3 months ago. They ask for your evaluation of the tubes. His right ear exam from the WiscMed Wispr otoscope is shown. What is your advice to the parents? The ventilation tube is properly positioned, patient and the eardrum is normal. No action is necessary. Ventilation tubes, also called tympanostomy tubes or ear tubes are often placed when a child experiences recurrent acute otitis media (AOM, “ear infection”). The tube is just like it sounds, a hollow cylinder that is placed through the ear drum. In this image, you can see the “backside” of the ventilation tube through the semi-transparent eardrum. The tubes purpose is to drain inflammatory fluid from the middle ear space and to equalize pressure on both sides of the eardrum. Normally, the pressure in the middle ear space is equalized by the Eustachian tube. The Eustachian tube is a hollow, noodle-like structure that connects the middle ear space to the posterior nasal pharynx (roughly the back of the mouth). When inflamed, the Eustachian tube becomes blocked, and it is no longer able to equalize pressure in the middle ear space. This causes painful bulging of the ear drum as seen in the example of acute otitis media below.

Acute Otitis Media (AOM) Example

In recurrent cases of infection, ventilation tubes are placed to mimic the function of the Eustachian tube. They are commonly placed in the anterior inferior quadrant of the tympanic membrane. The tube drains inflammation in the middle ear space and relieves the painful middle ear pressure. Almost everyone has experienced mild middle ear pressure when an airplane descends. We unconsciously know to increase the pressure in our mouth which expands the Eustachian tube and “pops” our ears, thus equalizing the pressure on both sides of the eardrum. This is technically known as the Valsalva maneuver. In this case, the ventilation tube appears to be patent. There is no bulging of the ear drum. The malleus bony landmark is clearly visible. There is no erythema. The child reports no discomfort. All these items suggest a normal eardrum aside from the presence of the therapeutic ventilation tube. Ventilation tubes typically fall out on their own in 6 to 12 months.