Introduction

The purpose of this information is to provide you with generally applicable information about this type of operation. Of course, it may be the case that certain aspects of this document are not applicable in your individual case or that they need to be discussed more or additionally with your surgeon. Remember to report to your surgeon all information regarding your general health, as well as any medications you regularly take (especially aspirin and related products, or other medications that may affect clotting). Do not forget to report if you have experienced any allergic reactions, especially reactions to medication. Bring recent medical records in your possession such as blood tests, radiologic and other preoperative examinations.

Purpose of the procedure

A malfunctioning Eustachian tube interferes with normal middle ear ventilation. Inadequate ventilation can have one or more consequences: recurring acute middle ear infection, hearing loss due to fluid in the middle ear and, at a later age, the collapse of the eardrum, which can cause a benign skin tumor (cholesteatoma) and/or permanent hearing loss.

The technical aspects of the operation

The placement of a transtympanic ventilation tube (also called a diabolo or tube for short) is done in children (and in some adults) under general anaesthetic. The eardrum is easily reached along the ear canal. A transtympanic ventilation tube is inserted through the eardrum under the view of a microscope after a small incision. The mucus that is usually in the middle ear can be immediately aspirated from the ear at the same time.

Immediate Effects

There is no pain upon awakening. There may be some (sometimes bloody) ear bleeding in the immediate aftermath. Only if this is very abundant can it cause premature shedding of the tube. Earring can also occur later on: this occurs in 1 or 2 children in 5 and often stops spontaneously after a few days. If the earring persists, this indicates an infection and it is best to consult a doctor; after all, these are ventilation pipes and not drainage pipes. Sometimes the tube can clog as a result of dried ear canal and the original problem can start again. If the hearing was impaired before, it will usually return to normal almost immediately after the procedure. However, this does not mean that “too much noise” should be avoided. The presence of the tube itself in the eardrum does not cause hearing loss.

Late Effects

It is normal and desirable for the tube to be expelled after a few months to over a year. How long this will last in each individual person is not predictable and can even be very different between left and right ear in the same person. Whether the problem will resume after expulsion depends on the functioning of the Eustachian tube (which in most cases in children gradually improves with age). Only very rarely does a tube fall inside; it does not necessarily have to be removed. In 1 to 2% of cases, the tube leaves a hole in the eardrum. This often happens in an eardrum that has already been damaged by inflammation. Incidentally, inflammation itself can of course also be the cause of a cavity.

Serious and/or exceptional complications

Any surgical procedure, even performed under ideal conditions and in the best possible way, can entail complications. Any intervention on an ear can cause irreversible hearing loss, ear murmurs, facial paralysis or (usually temporary) balance problems, but this is extremely rare when a transtympanic ventilation tube is placed. The same applies to causing a cholesteatoma (a benign skin growth), by enclosing a piece of skin behind the eardrum when it is punctured. One must weigh the (extremely rare) occurrence of serious complications against the benefits that can normally be expected from this procedure, and certainly not forget that "not intervening" can sometimes also have serious consequences.

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