Ventilation tubes

definition

A tympanic tube is a tube inserted into the eardrum that connects the external ear canal to the middle ear. Figuratively, it ensures that there is a hole in the eardrum for a certain amount of time. It can be made of a variety of materials such as silicone or titanium as needed.
The therapy goal of the tympanic tube is to drain secretions from the middle ear and thus to ensure good ventilation of the tympanic cavity. The healing of inflammatory or injury-related processes in the middle ear is thus promoted.

When do I need a timpani tube?

Any accumulation of secretions in the middle ear may be an indication for a tympanic tube. Most commonly, this occurs in the context of middle ear infection. The decision for the introduction depends mainly on the amount of liquid accumulated and less dependent on the type of secretion. At the medical examination this can be determined by a consideration of the eardrum. The more secretions have accumulated in the middle ear, the more the eardrum is directed towards the examiner. An outwardly curved eardrum thus speaks for a high pressure in the middle ear, which may need to be relieved by means of a tympanic tube.

Another clue to the examiner is the "hammer grip" in the middle of the eardrum as part of the ossicles. If the fluid level exceeds this anatomical structure, then at the latest the indication for a tympanic tube should be considered in connection with the symptoms of the affected person.

Since the eardrum is also parchment-like, both structures behind it and the nature of the secretion can be guessed. Yellow-whitish secretion speaks for inflammatory processes with pus formation and reddish secretions for a bloody fluid accumulation. These two secretions also sometimes speak in favor of a tympanostomy tube, as inflammation may spread to the inner ear and blood may clog the auditory ossicles. Here, however, it requires the exact assessment of an ENT doctor.

How is the surgery going?

In itself, the introduction of a tympanostomy tube is not a proper operation, but rather an outpatient procedure. It only takes a few minutes and usually does not require further hospitalization. The procedure itself, however, injures the eardrum, so that education about the course and the possible risks is necessary. This gives this little intervention its surgical character.
In order to make the use of the tympanum tube as pleasant as possible for the person affected, anesthetization of the eardrum is necessary. This can be done locally by applying an anesthetic to the eardrum in the form of a solution or by administering an analgesic in the form of an infusion. If the victim chooses local anesthesia, he is awake throughout the procedure and can in principle go home or be treated further.
If general anesthesia is considered, this is usually due to the planned further treatment of the middle ear during the procedure. If flushing or further rehabilitation of the middle ear is necessary, general anesthesia is necessary for a short time. Fear or agitation play an important role in children's decision to undergo general anesthesia.
If the eardrum is stunned, it is opened by a scalpel in the lower front quadrant with a small slit. The tympanic tube is then inserted into this slot. It requires no further attachment, since it adheres to the few released blood by the injury of the eardrum and thus finds support in a natural way. If the tympanic tube is introduced, the procedure is already over and requires a short follow-up of the person concerned. After general anesthesia, a short inpatient stay should be considered on a case-by-case basis.

aftercare

The post-treatment requires further therapy of the triggering cause.
Usually a middle ear infection has been the indication for a tympanic tube. The adequate therapy by fever-reducing agents, analgesics and antibiotics is therefore an important component of the post-treatment in addition to a regular control of the position of the tympanic tube. In the acute disease, this means for the doctor, the patient concerned in intervals of a few days to reinstall the medication, if necessary, to be able to adjust and to guarantee the outflow of the secretion on the tympanostomy tube.
If the disease is overcome, the tympanostomy tube is left in most cases. It is even repelled by the body and guarantees a complete healing process. With the renewal of the eardrum in the injured area, the tympanic tube is advanced piece by piece in the direction of the external auditory canal. With the cover of the tissue defect, it falls into the outer ear canal and is often unconsciously lost because of its small size.
The restored eardrum therefore speaks for a healed process, since it can only grow together completely by the absence of pathogens or secretions. On the other hand, too much tension would be due to accumulated fluid on the eardrum, so that its wound edges could not close. Therefore, one waits for the natural healing process of a few weeks.
A follow-up check in a generous distance is therefore justified after the acute treatment by a registered doctor.

How long does the timpani tube have to stay?

It depends entirely on the degree of the disease, how long the tympanic tube must remain in the eardrum.
In an acute illness, it should be left until complete healing. If there are chronic complaints, it may also be necessary to stay for up to twelve months.
If it is introduced due to an acute otitis media, it is usually rejected by the body within a few days to a maximum of two weeks. During this time sufferers also suffer from a malady, so that the tympanic tube even with significant improvement still has a right to remain and further healing further supported.

How is the tympanum removed?

In most cases, the body itself removes the tympanic tube. During the natural healing process, it is pushed by new tissue in the direction of the external auditory canal. Figuratively, this can be explained by its natural form. It resembles a funnel whose narrowing points towards the middle ear. The tympanic tube is located in the lower front quadrant and thus has its main weight by gravity towards the outer auditory canal. So if the defect is closed in the eardrum and thus repelled the material recognized as foreign body of the tympanic tube, it falls outward and not towards the middle ear.
Should this process fail, the tube can also be removed manually by the doctor. Especially with T-shaped tympanic tubes in the context of a long-term therapy, this is the case. By pulling on the tube, the carriers fold together behind the eardrum and the tube can be easily removed.

How long is the maximum allowed to wear a timpani tube?

The duration of a tympanic tube is determined by its shape and the choice of material.
A long residence time is ensured mainly by a T-shape. The roof of the T's lies behind the eardrum and prevents the material from being rejected by the healing process. The choice of silicone as a material promises in addition a good compatibility, so that the eardrum is influenced as little as possible by the introduced foreign body. If optimal fit and tissue compatibility is provided by these factors, a tympanostomy tube may remain for up to one year and longer. However, there should be regular control over the permeability of the tube.

What risks exist?

The installation of a tympanic tube is a relatively low-risk treatment. The biggest risk is the incorrect insertion of the tympanic tube in the eardrum. It is important that it is used in the anterior lower quadrant. Incorporation in another quadrant could result in injury to underlying structures of the ossicles. The injury can then manifest itself in a reduction in hearing.

Bleeding is not expected in the procedure. Although the eardrum is a perfused part of the ear, it does not carry any large vessels. The surrounding structures are also largely bony or cartilaginous and do not harbor the risk of a large source of bleeding.

The fear of a too large cut in the eardrum is quite justified. Too large a cut can mean that the tympanum tube can no longer be safely anchored in the artificially created hole. Here, however, the affected person can be reassured that the eardrum has a good ability to regenerate. As a rule, it heals within a few weeks and the goal of acute relief of the middle ear was nevertheless achieved. In addition, each medical cut is usually smaller than a natural tear of the eardrum.
A rupture of the eardrum occurs naturally when the collection of secretions exerts too much pressure on the eardrum. The installation of a tympanic tube comes before that and minimizes the defect. In the optimal case, the diameter of the tube is therefore about one millimeter.

How strong are the pains after?

If pain occurs in connection with the installation of a tympanic tube, these are usually not justified by the tympanic tube itself. Rather, it is the circumstance such as a middle ear inflammation which leads to the pain. Especially the discharge process of accumulated secretions from the middle ear via the tube can be painful at first, because the secretion flow irritates the inflamed mucous membrane in the middle ear.
However, experience has shown that sufferers experience less pain after insertion as they are deprived of pressure from the taut eardrum.

What can you do about it?

It depends on the intensity of the pain which analgesic measure should be chosen.
In case of mild pain, a shift of the head often helps to bring about an improvement. Here, the person affected must decide individually whether lying on the side or sitting upright helps better. If this simple measure is not sufficient, it is recommended that you take a painkiller with an anti-inflammatory component such as ibuprofen for stronger pain. The dosage should be made according to age and after package insert. In case of persistent pain, a doctor should always be consulted.

What to do if the tympanum is clogged?

If the tympanum is clogged, there are two alternatives to solve the problem

  • In some cases, the obstruction can be solved by the ENT specialist without removing the tympanic tube. In the majority, there are in fact slight incrustations by dried secretions or earwax, which lay the opening of the tube. A slight detachment provides remedy in these cases.
  • If it is not possible to restore patency, the tympanostomy tube must be replaced.
    This process is much easier than the initial installation of the tympanostomy tube. For this, the eardrum is usually stunned locally and the clogged tube removed. It is replaced by a new tube, which is used in the same place.
    In order to prevent re-plugging, it may sometimes be necessary to choose a tube of a different diameter or material. Thus, small particles in the secretion can no longer clog the lumen or adhere to the material.
    Especially platinum tubes made of gold-platinum are suitable here, as they have an additional antibacterial effect. A possible surrounding swelling around the opening is thus prevented and allows a perfect emptying of the secretion. However, silicone tympanic tubes conduct secretions just as well and are recommended for their good formability to the tissue.

Why does secretion run out of the ear?

The purpose of the tympanic tube is to establish a connection between the external auditory canal and the middle ear. This is to ensure the ventilation of the middle ear and the outflow of pent-up secretions. So runs the ear after inserting a tympanic tube, this speaks for a successful therapy.
The secretion is directed outward through the tube and manifests itself in an outflow from the ear. Depending on the type of secretion, this can take on a clear to yellowish color and vary greatly in the smell.
The rule of thumb should be a gradual reduction of outflow over days. The depleted secretions should also eliminate the agents from the middle ear. An increasing outflow speaks for a complicated healing process and should be clarified medically.
In general, the discharge should be intercepted with cotton wool in the external auditory canal. Loosely introduced into the ear canal, the cotton absorbs the secretion and can then easily be removed. The regular change is very important here, otherwise a renewed infection is possible. This may be necessary every four hours at the beginning of therapy.
Those affected should not be scared about the amount of effluent, but should support a smooth emptying. This can be achieved by an additional lying on the affected side.

Can I swim with a timpani tube?

Swimming is not recommended with a tympanic tube.
Normally, the water is stopped by the eardrum. In a tympanic tube, it can pass through the eardrum and enter the middle ear as well as secretions from the middle ear into the external auditory canal. The sterile space of the middle ear can thus come into contact with pathogens during swimming, which could infect both the ossicles and the adjacent inner ear.
In addition, the middle ear is otherwise filled only with air. Water could also do physical damage in this area and affect the vibrational capability of the structures. Using earplugs is a solution for swimming with a tympanostomy tube. In this case, however, the optimal fit must be ensured by a hearing care professional.

What kind of water protection is there?

The use of a water protection is absolutely necessary with a used tympanic tube. However, which water protection should be used depends on the humidity and the extent of wetting with water.

  • For outdoor use usually the use of cotton wool in the outer ear canal, which should be changed regularly.
  • When showering cotton is sufficient even with a careful use of the shower head. However, anyone who can not guarantee water intake should use earplugs. For showering, commercially available earplugs from the pharmacy are sufficient.
  • However, if you want to swim with tympanostomy tubes, they should be adapted to a hearing care professional to ensure an optimal fit.

May one fly with a timpani tube?

Sufferers can safely fly with a tympanic tube in an airplane. The pressure equalization can be done via the tympanostomy tube as well as via the excursion of the eardrum. The only difference with a lying tympanic tube is that the eardrum does not deflect until very little, as the air can pass freely through the eardrum. From a purely objective point of view, pressure equalization during take-off and landing is even easier and more agreeable for those affected, since the well-innervated eardrum is not irritated and no pressure is created.

Is it possible to do an MRI with a tympanum tube?

It has to be decided on a case-by-case basis whether an MRI can be easily performed with a lying tympanic tube. For details, the manufacturer of the implant should be consulted. However, it depends on the material of the tympanic tube, in general, whether the built-up magnetic field is disturbed during the examination.
As a rule set that tympanostomy tubes with silicone are generally safe for an MRI and metal-containing tubes require further consultation.
In any case, the affected person must always truthfully indicate the presence of a tympanostomy tube, so that no damage is caused by the examination.

The peculiarities of the tympanic tube in adults

The real peculiarity of the tympanic tube in adults is that it is less often required. The greatest risk of middle ear infections with a collection of secretions can be found in childhood. Adults rarely have this disease. However, if a tympanum tube is necessary, the procedure and the handling is exactly the same as in children. However, the procedure is almost always performed on an outpatient basis under local anesthesia, whereas in small children it is more likely to be under a short general anesthetic.
To the everyday life with the Taukenröhrchen is to say that adults are possibly exposed to other circumstances than children. Specifically, this means, for example, to be adequately protected against noise pollution at the workplace by means of adequate ear protection when the tympanostomy tube is lying down.
In contrast to children, there are also more chronic cases in the few adults that require long-term therapy. Not infrequently, therefore, the remaining of the tympanic tube amounts to more than a year. Here then there are other factors to exclude as possible causes and if necessary to treat with. For example, in adults, the paranasal sinuses and the mouth and throat area must be investigated as possible triggers.

What is the cost of putting a tympanum tube?

The cost of inserting a tympanum tube is covered by the statutory health insurance. However, depending on the health insurance, additional costs for customized earplugs may arise after the procedure, which may be needed for showering or swimming. Here it is necessary to get in touch with the own health insurance and to clarify a partial or complete reimbursement of costs.

What are the alternatives to the tympanum tube?

The alternative to the tympanic tube is the natural tearing of the eardrum by the secretion jam. If the pressure on the eardrum is too high due to the accumulated fluid in the middle ear, the tissue tears as a result of the overload. The effect is the same as a tympanum tube. It creates a hole in the eardrum and the secretion can flow away through the external auditory canal.
In contrast to the installation of a tympanic tube, however, this happens later. Sufferers often suffer from earache for a longer period of time and possibly a throbbing sensation in the ear. However, if the pressure is equalized, the sensation after the use of a tympanostomy tube is equated.
The further healing process, however, differs. A torn eardrum contains no foreign body and can heal completely after secretion drainage. The crack is closed again within a few days to a few weeks. The wound edges stick together relatively quickly and form a flat eardrum. In a tympanic tube, the opening remains longer because the tissue must repel the foreign material.

The alternative to the tympanic tube is therefore the body's own handling of the secretion in the middle ear. There is no right or wrong in this regard. It can only alleviate symptoms and shorten the course of the disease somewhat. The natural tearing and healing of the eardrum does not represent a disadvantage in the acute course of the disease.

Only in chronic processes should the natural tearing be avoided.


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