The Power of the PE tubes

 PE tubes are often times the first surgical intervention in a patient’s life.  Parents, especially young or new parents, are often anxious about the thought of putting their little one to sleep.  They are frequently full of self doubt concerning the risk benefit aspects of this procedure.  I often hear them saying: is this really necessary? will they cure the ear infections?  Isn’t there some other treatment that can be done?  I am writing this Blog in a attempt to explain the utility of PE tube placement, demystify the function of PE tubes and to try and answer some of these FAQ’s.

There are several indications for putting tubes in kids ears:
    -recurrent ear infections, greater than 3 in a 6 month time period
    -Chronic middle ear fluid (present longer than 3 months despite medical treatment)
    -The presence of eardrum retraction, considered a sign of chronic negative pressure in the middle       ear.
The purpose of PE tubes is to bypass the normal function of the eustachian tube(ET).  The ET ventilates the middle ear(ME)space.  An example would be when you drive up a mountain or ascend in an airplane and you get a plugged sensation in the ear.  After this you swallow, or chew, or yawn and the ear pops.  This represents the ET opening and allowing air to passively go into the ME and equalize pressure-the popping sensation.  Kids, or adults, who have ET problems can’t do this.  The negative pressure stays there and sucks fluid from the surrounding tissues.  This is where the fluid comes from.  The fluid has salts and sugars and all those things that bacteria need to grow and an ear infection develops. By placing the PE tube we bypass the normal function of the ET and keep the ME negative pressure from developing.  Thus middle ear infections are prevented. Myringotomy with PE tube placement came into vogue in the later half of the last century.  The procedure is done under general anesthesia via mask and involves making a small incision in the eardrum, sucking out any fluid that is present behind the eardrum and placing a small tube (grommet) through the eardrum incision.  It is one of the most frequently performed procedures in this country.  The patient, generally, goes home the same day
    There are some important concepts/misconceptions regarding PE tubes:
     -Some patients think the PE tubes are drainage tubes.  They are not.  PE tubes are ventilatory         tubes, as outlined above.
      -Some people think the “PE” in the name of the tubes stands for “pneumatic equalization”.
       This would be appropriate since this is exactly what they do.
       -Some people think that when a patient with PE tubes present has a draining ear it is okay,             the tubes are doing their job.  This is not okay.  Drainage from the ear after tube placement is         a sign of infection.  Infected material from the ME is coming through the tube and out the ear.
       The patient needs to be started on antibiotic drops, pills or both.
      -Some people think that Otolaryngologists(ENT doctors) are “tube happy”.  That we put in               tubes indiscriminately just to increase profits.  This is not true.  There are stringent guidlines
       and most, if not all ENT doctors follow these when considering PE tubes.  You need to
       understand that prior to the advent of PE tubes chronic ear disease was much more                       prominent than it is today.  A complication of ear disease, mastoiditis, which can be a surgical
       emergency was seen far more frequently in the days prior to PE tube use.
      -Some people think that ME fluid that is not infected is okay and needs no treatment.  This is
       wrong.  The presence of ME fluid causes a small hearing loss and this can adversely effect
       a child’s speech development and/or scholastic achievement.
      -Some people think that PE tubes are a be all and end all in regard to ear infections.  They             are not.  Kids can get ear infections even with the PE tube present.  Our goal is to decrease
       the severity/frequency of the ear infections with the tubes.
      -Some people think that a patient with PE tubes cannot go swimming with tubes.  This is not
        true.  It is true that dirty water can go into the ear canal, through the tube, into the ME and
        cause an infection.  In young children who are just going to splash around in a kiddie pool I
        don’t do anything.  I do recommend that when bathing/washing hair you use fresh water
        from a shower massage or faucet to rinse.  In older children/adults you can use ear plugs to
        keep the water out when swimming/bathing.
       -PE tubes are temporary, they stay in place 6-18 months.  Some patients lose their tubes                early and some hold on to their tubes for a long time.  In my office we see patients after PE
        tube placement every 6 months to let you know when the tubes fall out and whether, or not,            the ear drum has healed.

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