7 Undesirable Ear Tube Complications (which may require more surgery!)

Ear infections represent one of the most common reasons children are seen by doctors. Nearly 75% of children under the age of 7 will have at least one ear infection, but most children outgrow ear infections as their immune systems and eustachian tubes mature.  Still, many children continue to have recurrent and chronic ear infections.

My previous blog posts highlight important ear infection facts, ear infection myths,  and complications of ear infections.

Ear Nose and Throat (ENT) surgeons place ear tubes which save millions of children every year from severe ear pain, hearing loss and use of antibiotics. Common ear tube questions and ear tube myths have been discussed to allow parents to better understand their potential value. Nevertheless, ear tube complications remain possible.

Mucous leaking out of tubes is NOT an ear tube complication. The need for more ear tubes after they successfully fall out is also NOT an ear tube complication. This blog addresses ear tube complications that frequently require additional surgery. Thus, these are true undesirable complications that result from the insertion of ear tubes.

7  Undesirable Ear Tube Complications

1. Ear tube blockage

During surgery, a small incision is made in the eardrum in order to insert the tube. Ear drops are typically prescribed after surgery to treat any remaining infection behind the ear drum and also to rinse away fresh blood so it does not clot and block the tube.

Many children fight ear drops, and parents are unsuccessful at putting in drops as directed. When the child is checked after surgery, dried blood or mucous may block the tube. Sometimes the tube can be opened but other times, new tubes need to be placed.

There may be new options available in the future to reduce the fight with ear drops after surgery. In the meantime, remember that ear drops after surgery can be very important.

2. Ear tube remains in ear drum too long

Tubes are temporary and need to come out of the ear drum. If the tubes do not fall out on their own, they will need to be removed. These are called retained ear tubes.

Depending upon how old the child is and how much of the tube has already started to come out, some tubes can be removed in the office. However, because the tube is still lodged in the ear drum, it may be very painful.

Tubes that do not fall out on their own sometimes require ENT surgeons to remove the tube in the operating room.

3. Chronic infection and irritation around the ear tube

Our immune systems are designed to attack substances that are recognized as foreign. This works well for viruses and bacteria. Tubes and other surgically implanted medical devices are often recognized as foreign objects.

If tubes do not fall out, the body increases the immune system attack, and the tissues around the tube become extremely inflamed. Eventually, swelling and irritation turn into infected granulation tissue. As more time goes by, this tissue matures into a granuloma  which can actually grow and completely cover the ear tube.

Antibiotics and ear drops are useful at treating this inflamed tissue but the main treatment option would include removing the ear tube to stop the  foreign body reaction.

4. Hole in ear drum (Perforation)

Most ear tubes successfully fall out of the ear drum into the ear canal while the ear drum closes. However, if tubes stay in the ear drum too long, scar tissue may form around it. This scar tissue then allows the ear tube to simply fall out of the ear drum without the slow growth to close the hole. A chronic hole in the ear drum (perforation) can then occur.

If the perforation is small , it may slowly continue to heal and close on its own. But many chronic ear drum perforations require a more extensive surgery to rebuild the ear drum and close the hole with a graft.

5. Ear tube falls out of ear drum into the middle ear

Extrusion is the process of the ear tube being slowly pushed out of the ear drum into the ear canal. In rare cases, the tube falls into the middle ear, and the ear drum heals over the tube. This process is called intrusion.

The tube trapped in the middle ear can stimulate a foreign body reaction and lead to middle ear infections, or fluid collection.

Surgery is required to remove the tube from the middle ear.

6. Ear drum scarring

Any chronic irritation of the ear drum, including recurrent ear infections or ear tubes, can cause ear drum scarring. This scarring occurs when white, hard calcium deposits collect on a normally thin ear drum.

Ear drum scarring is called tympanosclerosis (TIM-pan-O-SKLER-O-sis) or myryngosclerosis (MER-ring-GO-skler-O-sis).

In most cases, the scarring causes no problem with hearing and does not need any treatment; however, the scar tissue can replace a large part of the ear drum or extend into the middle ear space. This more aggressive scarring may cause significant hearing loss and need surgery to correct it.

7. Cholesteatoma (KO-less-TEA-uh-TOE-muh)

You may or may not have noticed, but many ear tube complications can also occur as a complication of recurrent ear infections.  One of these severe complications that can occur, even if a child never requires ear tubes, is the dreaded cholesteatoma.

The process for cholesteatoma formation around the ear tube occurs because the tube can trap skin under its edges where it may not be easily seen. Skin then grows into the middle ear and can cause severe damage to hearing structures or lead to life threatening infections.

Potential trapped skin that may not be visible is one of the reasons that ear tubes must be removed if they do not fall out.

The ear drum is not supposed to have a permanent connection from the outer ear to the middle ear. Make sure your ENT surgeon or pediatrician has clearly told you that the tubes have fallen out of the ear drum to avoid these undesirable ear tube complications.