PE Tubes

P E tubes are small pressure equalizing tubes placed through the ear drums when the natural openings behind the ear drums are blocked causing unequal pressure, fluid buildup, or infections. This restores the ear space to its’ normal aerated condition.

The most common surgical question an Ear, Nose and Throat Specialist is asked is “Does my child need PE Tubes?” The answer to that question involves communication between the parents and the doctor so that each understands the other’s thoughts, perspectives and the facts. The answer is an opinion, but not an absolute fact, as to what constitutes the best course of treatment for that individual patient. Physicians both in different specialties and in the same specialty may differ some between opinions without either being wrong. I hope that it will be helpful for me to share my thoughts on how I decide whether or not to recommend PE tubes.

First, I want to know how many infections have occurred in the past one year. I like to see at least five or six during the first year of life before considering tubes. It is rare for a child under 6 months old to have this many. Kids often outgrow ear infections but winters are usually worse. If a child has already had multiple infections heading into winter I tend to be more inclined to recommend tubes. Toward the late winter I prefer to wait longer to see if better weather will help. If the infections have caused seizures, high fever, or a lot of pain, or if they have been difficult to clear with strong antibiotics, I might lower my threshold to three or four infections before recommending tubes. Severe or multiple infections do run a mild risk of permanent hearing damage in addition to causing suffering. Persistent ear fluid ( without pain or fever) lasting three months despite antibiotics in a child under three would cause me to recommend tubes. Fluid decreases hearing which is critical for speech and language development which can be delayed if poor hearing persists. In older children I might wait a little longer but only if I can test their hearing and make sure it is not decreased too much. Since siblings often have similar ear, nose and throat problems, I tend to recommend tubes a littler earlier in a child if an older brother or sister ended up needing PE tubes and the child in question seems to be following the same pattern. These problems are usually connected to inherited genes affecting the immune system and especially allergy, sinus, tonsil and adenoid problems. So not only do these problems often run in families, but kids needing PE tubes often have problems with sinusitis, tonsillitis and allergies (more on that another day). Until their immune system develops better resistance and all the ear and sinus openings in their heads enlarge with growth, young children get sick more easily with colds and infections which can then go to their ears. Second hand cigarette smoke and being around other sick children (day care and school) are the two biggest factors increasing infection risk. Environmental control of allergic factors along with good health and nutrition habits can help.

If there is ever any doubt in deciding about whether or not to insert PE tubes, a second opinion from another doctor or specialist is often helpful, as well as talking to mothers of kids with tubes.

PE tubes are not 100% effective in stopping infections, but help tremendously in most kids. Along with better antibiotics they have markedly decreased severe complications from ear infections. It is a safe, simple and effective solution to ear infections not controlled with antibiotics.

Dr. Chuck Guice