Hellobee

BILATERAL MYRINGOTOMY WITH TUBE INSERTION:

Those words are scrawled across the top of our surgery intake forms. Forms I’d hoped we wouldn’t have to deal with when Baby Oats was less than a year old.

I wrote here about our experience with newborn hearing screening and hearing loss, and how we had adopted a bit of a ‘wait and see’ approach in regards to Baby Oats’ hearing. After failing the infant hearing screening, and being diagnosed with a bilateral mild conductive hearing loss at 2 months old, we then began waiting for a referral to an ear, nose and throat specialist. Thankfully, I’m an audiometric technician in an ENT office, so we got in pretty quickly.

Sure enough, there was a huge build up of fluid behind Baby Oats’ eardrums. We tried an experimental 6-week course of antibiotics to clear the fluid, and amazingly it worked. By about 6 months old, the fluid had cleared, and Baby Oats’ hearing was close to ‘normal’. However, he’d had a series of ear infections, so we still weren’t in the clear. One more ear infection, and the ENT would recommend tubes.

A few days ago, we headed back to the ENT for a checkup. Baby Oats has been sick on and off for a few weeks, and I knew that there would be some fluid buildup. Unfortunately, there was way more fluid than necessary, and it’s been causing a fair bit of discomfort. The doctor gave us a choice; try another 6 week round of antibiotics, or go ahead with the tube insertion. Though the antibiotics worked last time, they only worked for a couple of months; 6 weeks of antibiotics for 2 months of fluid-free ears wasn’t really worth it, especially because we’d be right back at this spot in another few months. So we agreed to the tube insertion, and scheduled the surgery.

I’m very familiar with the process behind tube insertion (a lot of my patients are kids who have just had tube insertions), and I understand the hows and whys. This is probably the single thing holding me back from being a panicky mess about my one year old going into surgery. So I figured I’d share a bit with you, in case you’re faced with tubes and don’t want to wade through Google for some answers.

Eustachian tubes run from the middle ear down to the mucous membranes in your nose and throat. They are usually collapsed, but swallowing, yawning, etc. opens the tubes to equalize pressure between your middle ear and the atmosphere around you. In infants, the eustachian tubes run horizontally, which means that any fluid in there just sits and becomes a breeding ground for bacteria. As you grow, the eustachian tubes move and stretch and become more vertical. This is why kids are so much more prone to ear infections; infected fluid in the middle ear means an infected ear.

Fluid builds up harmlessly behind our eardrums all the time, with sinus infections, colds, or allergies, but when the illness clears up, so does the fluid. When it doesn’t drain and the pressure is too much, it can decrease hearing, cause a lot of pain, and potentially rupture the eardrum. I see several adults each week who have ruptured or perforated eardrums, and often this is a cause of a severe ear infection (at least one a week is because someone has stuck something into their ears that shouldn’t be there. I’m looking at you, Q-tips).

In children, continuing ear infections, fluid build up and eardrum perforations can have a huge impact on hearing, and eventually on speech. Because a good deal of my training is in speech therapy, I feel like I’m hyperaware of Baby Oats’ speech development. Little Oats had probably 10 words by age one, and since Baby Oats has none, the irrational mama bear in me is freaking out (is he only using repeating consonants? Why doesn’t he say mama? Totally normal…but I’m still a panicky mess). Over time, decreased hearing leads to difficulties in speech, attention, and learning, especially if it goes untreated or undiagnosed. This is why a tube insertion is a great solution to this sort of hearing loss.

Okay, but what does ‘myringotomy’ mean? And what exactly does a tube DO?

Simply, a myringotomy is putting a small, surgical hole into the eardrum to relieve pressure and drain fluid. All of the fluid that has been building up behind the eardrum due to eustachian tube dysfunction needs to go somewhere, so draining it out through the eardrum is the easiest course. A small plastic tube is then inserted into the hole; this keeps the pressure equalized between the middle ear and the atmosphere. This will also allow any fluid that gathers to drain. Over time, the eardrum will start to heal, the ear will grow, and the tube will work its way out of the ear canal. Hopefully, this has given enough time for the eustachian tubes to start functioning properly, though a second tube insertion is sometimes needed.

Now, I said above that a hole in the eardrum is a BAD thing. Sure, when everything is functioning properly, a hole in the eardrum isn’t good. But when it’s put there surgically, it can be extremely helpful. It does cause a few problems until the hole heals, however. Any water that gets into the ear can be potentially harmful, and without the eardrum as a protective membrane, infection is much more likely. And a middle to inner ear infection is a lot more serious (and painful) than your standard fluid build up. This is why kids who have had tubes need to wear earplugs in the bath, shower or pool. Some doctors will prescribe antibiotics post-surgery to prevent infection, but others just recommend careful watch to make sure no water gets in the ears.

We haven’t taken Baby Oats in for surgery yet; he’s scheduled for the end of September. I know what to expect, but I’m still pretty nervous. He’s so little, and even though the surgery takes about 4 minutes from start to finish, I’m worried about anesthesia, his pain levels, and what’s going to happen going forward. But I know that he’s in good hands, and we’ll make it through just fine.

Who’s experienced tubes? I know there are lots of you out there! Any tips for a first-timer?