Question: My daughter is 6 years old and suffers from eustachian tube blockage (dysfunction). She has chronic fluid in her middle ear. She had a third ventilation tube put in her left ear in June 2012, and that ear is doing fine. Her right ear had a fungal infection which caused its second ventilation tube to fall out and created a perforation that lasted for nearly a year. The doctor thought it would not heal on its own, however, in December 2012 the perforation had closed.
The right ear now has a retracted eardrum. It is not a pocket, but rather the entire eardrum is retracted. The recommendation is to place a ventilation tube in that right ear and also remove the adenoid. I’d like to know if the retraction should be corrected with a vent tube or if this will cause an increase in the possible recurrence of the retraction. What is a safe amount of time that we can monitor a retraction if we choose to observe, rather than surgery?
Also, have any studies been done that can conclusively say that removing the adenoid will decrease the middle ear fluid? I would love to read current studies and recommendations for children with middle ear fluid.
Thanks for your question. Unfortunately, your daughter has had a lot of trouble with her ears, but the good news is that she and you should get through this fine.
We place ventilation tubes through the eardrum to drain the middle ear in children (and adults) whose own normal drainage through their eustachian tubes is not working well. In these people, fluid builds up behind the eardrum and can cause infection and hearing loss. Only if the fluid fails to drain, do we recommend drainage tubes. They tend to stay in about 6 months, and then come out on their own. You usually don’t feel the tubes, or when they come out, but they should help in terms of middle ear infection and bringing back any hearing loss caused by the fluid. Putting in tubes doesn’t really get to the cause of the eustachian tube blockage (dysfunction) but usually allows time for your child to “grow out” of the problem.
Studies by Maw in England showed that if children needed a second set of tubes, an adenoidectomy if done at that second time, would lessen the need for a third set of tubes by almost 50 %.
Paradise in Pittsburgh showed that if an adenoidectomy were done at that second set of tubes, children spent 47% less time with fluid the first year after and 37% less time with fluid the next.
Usually, one would suggest doing an adenoidectomy should your daughter need tubes again. We do recommend putting tubes in for eardrums that are getting “retracted” or sucked back. The hope is that the tubes allow air to get into the middle ear space and push the eardrum back to its normal position. Once an eardrum is scarred in a retracted position, there may be a persistent hearing loss. I don’t know of any study saying how long one can observe a retraction, as I believe the development of scarring in that position is quite variable. I would discuss this with your doctor.
The good news though is that she is already 6, and most children are aging out of the problem about this age. There always is a possibility that this will resolve without further intervention, but it is hard to predict.
Robert Pincus MD
NY Otolaryngology Group