Eustachian Tubes & Ventilation Tubes
What is the eustachian tube?
The ear is divided into 3 parts: the external, middle, and inner ears.
The external ear is the ear canal and is separated from the middle
ear by the eardrum. The middle ear is a tiny chamber on the other
side of the ear drum which contains the middle ear bones. When
working properly, the middle ear conducts and amplifies sound on
its way to the inner ear. To work efficiently, the middle ear
chamber must be filled with air. Unfortunately, air is constantly
being absorbed in the middle ear and this must be continually
replaced. The air is supplied by the eustachian ( pronounced U-
station) tube, a soft, collapsible pipeline connecting the middle ear
to the back of the nose.
What is the problem?
When the eustachian tube is not opening properly and the air of the middle ear
space is absorbed, a vacuum is formed. The eardrum is pulled into the middle ear
and fluid collects in the middle ear; this causes a hearing loss. This abnormal
environment also favors growth of germs which leads to a middle ear infection. In
other words, eustachian tube dysfunction results in two common problems:
recurrent ear infections and persistent fluid in the middle ear.
Fluid often lingers in the middle ear after an infection and needs no specific
treatment. We become concerned when the fluid does not disappear within a
three month period. In children, prolonged fluid in the middle ea is of particular
concern because this problem can lead to delayed learning and speech
Why does the eustachian tube not work?
About one out of every three infants has some trouble with ear infections. This is probably because there
is a period in many young children s development when the eustachian tube does not work effectively.
Children whose parents had frequent ear infections in their childhood will often inherit this problem.
There are a number of additional factors which cause the eustachian tube to malfunction. Commonly, a
cold ( viral infection) or allergies ( such as dust, grass, or pollen, as well as food allergies) will cause
the eustachian tube to swell and malfunction. Other factors, such as second-hand smoke, bottle-feeding,
and day-care centers are associated with increased problems with the eustachian tube. Luckily, as we
grow older and bigger, the eustachian tube usually works better and these problems disappear.
Unfortunately, some do not outgrow this problem as quickly. About 1% of adults continue to have
problems and often complain of popping and crackling as well as a fullness or loss of hearing in one or
When a child has frequent infections, the doctor may recommend using prophylactic antibiotics. This
involves taking a small dose of antibiotic once a day for a month or longer to hopefully prevent infections.
Middle ear fluid usually drains out within 3 months if no further infection occurs. Unfortunately, when this
natural clearing process fails to occur, there is very little we can do with medicine to encourage it.
Avoiding aggravating factors ( such as cigarette smoke) and using drugs ( such as antihistamine or
decongestant) may help, but often all efforts are unsuccessful. Children with symptoms suggestive of
allergies should have this issue discussed with their doctor. If all of these measures fail, it is valuable to
consider placing a small ventilation tube in the eardrum.
The purpose of a ventilation tube, also called pressure equalizing ( PE) tube, is to temporarily take over
the job of the eustachian tube when it isnt working well. This does require a brief surgical procedure. It is
usually performed under general anesthesia and takes about 15 or 20 minutes. Looking through a
microscope, your surgeon will make a tiny incision in the eardrum and, if fluid is present, suction it out. If
nothing else was done, the incision would heal within a few days and the problem of ear infections or fluid
might start again immediately. To prevent this, the surgeon places a tiny tube in the eardrum.
It has an opening the size of a pinhead which is all that is needed to let air circulate
through the middle ear. The ventilation tube usually remains in the eardrum for at
least 6 months, but maybe as long as a few years.
After the ventilation tubes fall out ( which is normal, your doctor will wait to see if the
eustachian tubes are working better. If not, a small percentage of patients will need
another set of ventilation tubes.
In some children, particularly age 4 to 8, an adenoidectomy is recommended. This is
usually reserved for patients who require a second set of tubes or have problems due
to enlarged adenoids. The adenoid tissue, which grows in the back of the mouth ( above the soft palate
and therefore beyond our view, may interfere with the opening of the eustachian tube and the back of the
nose. Adenoid tissue is also a source for germs. An adenoidectomy is usually a quick, minimally painful,
and low-risk operation.
What are the advantages of ventilation tubes?
1. Fewer ear infections. In most children ventilation tubes significantly reduce the number of infections.
When they do occur, they should be less painful and easy to recognize because of the drainage from
2. Fewer antibiotics. Ventilation tubes usually reduce the need for antibiotics, which therefore reduces the
risk of the patient developing an allergy to an antibiotic and reduces the risk of the bacteria
developing a resistance to the antibiotics.
3. Elimination of the middle ear fluid. Once the tube is placed, it will immediately eliminate the temporary
conductive hearing loss created by the middle ear fluid. This may also reduce the risk of long-term
speech and learning problems. It may even reduce the risk of long-term scarring and retraction of the
What are the disadvantages of ventilation tubes?
1. It is a surgical procedure. Although this is a brief and relatively uncomplicated task, it usually requires
a general anesthetic. This is recommended because the procedure is difficult to perform in a patient
who might move unpredictably. In older children and very calm younger children, it may be possible
to perform the procedure under local anesthesia in the office. The child s safety is our primary
2. Ear infections still occur. Unfortunately, despite your best efforts, ear infections can still occur. In a
very small number of cases they may be difficult to stop because the tube can act like a foreign body.
At the discretion of your doctors, the ventilation tube may even need to be removed.
3. Tubes are only temporary. Under most circumstances the tube stays suspended in the eardrum for 6
months to 2 years. At some unpredictable length of time the eardrum will push the tube out and into
the ear canal. The tube will later fall out with the earwax. It is usually difficult to see or feel the tube.
Once the tube falls out, the eardrum will usually heal by itself; and there is no clear evidence that
ventilation tubes interfere with the function of the eardrum.
4. Injury to the eardrum. In less than 1% of cases, the hole does not completely close and may later
require a procedure to patch it. Rarely, the tube can fall into the middle ear.
5. Water precautions. It is usually not necessary to change any of your normal bathing or swimming
routines. You will not need ear plugs unless diving more than 6 inches underwater or if water is
causing ear pain. Silicone and customized ear plugs that float are available at a reasonable cost at