The Medical Consumer's Advocate

Eardrum perforation following ventilation tube extrusion

 

Q: My ZZ-year-old son had tubes put in his ears at six months old. These helped the problem with chronic ear infections but there was a hole left in one ear that never closed. A paper-patch surgery was done, but this did not close the perforation. Another more extensive surgery was done where they went in behind the ear to do the repairs but this also has not been deemed to work. Hearing tests have proved to be okay so far, but I am worried about long term effects. Would it be in my son's best interest for me to take him to another ENT? Is there something else that could be done? The last operation was painful, and he is not looking forward to another.

A: Ventilation tubes are extremely helpful for infants and children who suffer from ear pain and hearing loss due to recurrent ear infections or persistent middle ear fluid. The tubes are placed so that they span the eardrum, thus allowing air to enter the middle ear space. Eardrums shed their skin very slowly, and in doing so, they eventually "spit the tubes out." This typically occurs 6 to 18 months after the tubes are placed. One of the unfortunate risks of ventilation tubes is that a nonhealing perforation may be present once a tube falls out of the eardrum. This happens rarely, but is very bothersome when it occurs.

These perforations are typically very small and do not impair hearing. In your son’s case, the hole is probably an annoyance because he needs to keep water out of the "problem ear." If he does get water in this ear, he could get an ear infection; if this happens often enough, it could affect his hearing and may even cause permanent hearing loss. Nevertheless, if he carefully avoids getting water in his ear, he will most likely never have problems due to the perforation.

The perforation does not necessarily prevent him from swimming; his ENT can explain what sorts of ear plugs and swim caps must be used in order to keep the ear dry. Still, kids are kids, and he may object to doing anything which sets him apart from the other kids. In my office, I sell (at cost) a variety of brightly-colored "ear bands." I have seen many children your son’s age who take one look at this head gear and shriek, "BUT, MOM!"

This point deserves emphasis: provided he is careful, he can live his entire life with a perforated ear drum; the perforation does not HAVE to be closed.

In some cases, perforations are associated with recurrent infections. Such patients are bothered by recurrent ear pain and drainage. For these patients, closing the perforation is a good idea because it will rid them of an annoying problem.

Does your son need to see another ENT? I suspect that you are asking this question because, after two failed procedures, you are beginning to doubt your ENT’s abilities. You need to know, however, that the paper-patch procedure often fails. We do it because it is a simple, painless office procedure; if it works, the doctor has saved his patient from having to undergo a bigger procedure. I would argue that your son has really only had one procedure (the operation) which failed. This procedure has a failure rate of 5% to 15%, regardless of the skill of the surgeon. No technique is perfect, and all operations have a risk of failure. Thus, the failure of your son’s second procedure may very well have been a simple case of bad luck.

In deciding whether to have another procedure, you need to ask your son how much the perforation is bothering him. In deciding whether to see a different ENT, you need to ask yourself how you feel about your son’s present ENT. If he is a kind, caring doctor who explains things well and has a good reputation in the community, I would suggest that you stick with him.

 

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