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Ear, Nose, and Throat Disorders

PE TUBES and side effects

07/20/2004

Question:

My daughter is 13 months old. She has had 6 ear infections (three of those were double one) since September. Her ped referred her to an ENT who has recommened PE tubes. Are there are negative side effects to these tubes? Are there other alternatives? Will the tubes cause scarring that can lead to other porblems?

Answer:

PE tubes are small tubes, usually only 1 mm in diameter, placed into the ear drum. The "PE" stands for 'pressure equalizing' and the purpose of the tubes is to treat the negative pressure in the middle ear space and subsequent middle ear fluid and infections that occur when there is long standing negative pressure present. The negative pressure occurs from malfunctioning of the eustachian tube, a small tube that courses from the middle ear space to the back of the throat, just behind the nose. The PE tube basically does the job of the eustachian tube which is to let air in and out of the middle ear space. Having the tube in place allows inflammation to resolve and gives the eustachian tube basically a rest so it can recover and start functioning better. The PE tube usually stays in 6-12 months and then the ear drum pushes it out. In most cases by then the child's own eustachian tube has recovered and does the job to aerate the middle ear space. The main problem with PE tubes is that your child will require a general anesthetic to put the tubes in. This is however a very short procedure (about 10 minutes) and if done in a hospital where many children have had surgery and they are comfortable with children, the risk is small. The most common complication with PE tubes is that you can still get an occasional infection with the tube in place. About 10-15% get an infection which manifests by drainage from the ear. This can easily be treated with an antibiotic ear drop and antibiotics by mouth are not usually needed. It is possible to get scar tissue at the site of the PE tube but this would only be a very small area of scar tissue and I have found it's more common to see scar tissue on the ear drums from the ear infections themselves. Occasionally, the hole may not heal when the tube comes out but this is rare in the small tubes that are usually used in young children. It is also possible, but rare, to develop a small skin cyst, called a tympanic membrane cholesteatoma, at the site of the PE tube once the tube falls out from the the eardrum not healing correctly but this is also rare in these small tubes. Your other options of treatment include continued antibiotics to treat the infections ( but with the multiple infections there is concern of developing resistance to the antibiotics). You should also be sure to eliminate any risk factors that may be predisposing your child to the ear infections such as cigarette smoke and day care classrooms larger than 8 children per class. If your child still uses a pacifier, you might want to get rid of it as this has been shown to possibly be a risk factor.

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Response by:

Sally R Shott, MD Sally R Shott, MD
Professor of Pediatrics
College of Medicine
University of Cincinnati