Ear tubes 101: How to know if your child needs ventilation tubes

Children's Health

by Baylor Scott & White Health

Feb 6, 2022

Sniffles and ear infections are childhood ailments that will be familiar to many, if not most, parents. But sometimes there’s a persistent runny nose that just won’t stop, or an ear infection that comes back around every month. And maybe your child’s words don’t sound quite right when spoken or she has trouble hearing you.

All of these are symptoms that your little one may be experiencing pressure behind their eardrums, a problem that can be addressed with ventilation tubes for their ears.

What are ventilation tubes?

Ventilation tubes—also known as pressure equalization (or PE) tubes—equalize the pressure behind the eardrum, where the problem lies. Children need ventilation tubes when their natural eustachian tubes don’t function properly.

A normally functioning eustachian tube should provide adequate pressure equalization and drainage between the middle ear and back of the throat. But sometimes the eustachian tube doesn’t do its job.

Why wouldn’t a eustachian tube function properly?

“There are a lot of reasons why your eustachian tube may not work right,” said David Randall Pinkston, MD, an otolaryngologist on the medical staff at Baylor Scott & White – Temple. “Frequent respiratory infections, allergies and anatomical factors—where it’s not shaped just right to stay open like it needs to.

Unfortunately, according to Dr. Pinkston, there’s really nothing we can do to make the eustachian tube work better. It’s located at the base of the skull in an area that doctors can’t operate on, so we have to substitute something for its function when it’s not working right.

That something is the ventilation tube.

“The two most common reasons for needing ventilation tubes would be for recurrent ear infections and persistent fluid buildup in the middle ear space that doesn’t clear when the infection is brought under control,” said Dr. Pinkston.

Recurrent ear infections

If a child is having recurrent ear infections—six or seven in less than a year’s time—doctors  generally recommend placing ventilation tubes in a child’s ear.

Persistent fluid buildup in the middle ear

In some cases, a child may have fluid in his or her middle ear space that doesn’t clear up despite antibiotic and antihistamine treatment. Dr. Pinkston said this excess fluid has the potential of dropping the child’s hearing threshold as much as 35 decibels, which may affect the rate and manner in which she learns to speak.

“It’s as if you filled your ear canal up with water and put an earplug in it,” he said. “You can still hear, but you obviously would struggle to hear. That’s basically what a child is going through when she has bilateral middle ear fluid. Most doctors would recommend tubes to get rid of that fluid so the child’s hearing would return to the normal range, because speech-language development is critical in the early years.”

How to tell if there’s fluid in the middle ear

Persistent fluid in the middle ear is determined by your child’s pediatrician or by an ear, nose and throat doctor (also called an otolaryngologist or ENT) using an otoscope. They will look inside the ear with it to and check for movement of the eardrum and its color.

If there’s little or no movement and it’s not its usual yellow color, your child may have fluid buildup in the middle ear space.

If your child’s doctor is uncertain whether excess fluid is present, an audiogram can confirm conductive hearing impairment. Fortunately, that hearing loss can be relieved once the fluid is drained.

Risk factors for developing persistent ear infections

Dr. Pinkston said there are three primary risk factors for ear infections that contribute to a child’s needing ventilation tubes:

  • Daycare: A child in daycare with many other children have a higher chance to develop repeated ear infections than those not in daycare, research shows.
  • Tobacco in the home: A parent or sibling using tobacco in the home is a causative factor in chronic ear disease in small children, research shows.
  • Bottle feeding: Research also shows bottle-fed babies are missing the protective immunoglobulins found in mother’s milk that babies who are nursed receive, resulting in more frequent ear infections.

If you think your child may have persistent ear infections and need ventilation tubes, talk to your child’s doctor or find a doctor near you today.

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