.png){kind=small}
.png){kind=small}
BackTable / ENT / Article
Complications After Ear Tube Surgery: A Comprehensive Guide
Taylor Spurgeon-Hess • Sep 22, 2022 • 16.5k hits
Ear tubes can provide relief from recurring ear infections and fluid buildup in the middle ear, but in some instances, complications after ear tube surgery may occur. Clinical decision-making comes into play when determining how to address clogged or retained ear tubes. The best course of action depends on a number of factors and can be influenced by patient age, comfort, and symptom presentation. Hosts of the BackTable ENT Podcast, Dr. Agan and Dr. Shah, discuss these factors and share the considerations they make when determining whether or not they should replace an old ear tube. They also share tips for treating other complications after ear tube surgery, including post-surgical blood clots, mucus, and tube otorrhea.
This article features excerpts from the BackTable ENT Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.
The BackTable ENT Brief
• Treatment for clogged ear tubes after surgery involves leaving the tube alone if the child does not experience other problems with hearing or development, but in the case of persistent ear infections, the clog can be treated with Floxin or Ciprodex. A diluted hydrogen peroxide solution of equal parts distilled or bottled water and peroxide can be applied to the ear via a dropper in order to help dissolve a clog.
• In adults, a retained ear tube can be left untouched unless the patient has a need for removal, such as a desire to scuba dive. Children can be papoosed and the tube can be quickly removed in order to avoid perforation.
• Patients who return to their follow-up visit after surgical placement of ear tubes may present with a blood clot in the ear which can either be picked out or dissolved with a diluted hydrogen peroxide solution.
• To address mucus in ear tubes that clogs them at home, patients can utilize a blue bulb syringe and a diluted hydrogen peroxide solution to thin and suction the mucus.
• The antibiotic ear drop, Ciprodex, is the first line treatment for tube otorrhea, and often relieves symptoms for most patients within a few weeks. If Ciprodex fails to treat tube otorrhea, and the patient has chronic sinusitis or severe allergies, a steroid drop, such as dexamethasone or Pred Forte, may be prescribed.
Table of Contents
(1) Treating Clogged & Retained Ear Tubes
(2) Determining the Necessity of Tube Replacement
(3) Treating Blood Clots and Mucus from Ear Tube Surgery
(4) Treating Tube Otorrhea
Treating Clogged & Retained Ear Tubes
Treatment for clogged ear tubes after surgery in a patient whose hearing is normal depends on the extent to which the clog is providing issues for the patient. In pediatric cases where the child is not experiencing any pain or ear infections, and the clog does not affect their speech, development, or hearing, it can be left untouched and instead can be monitored. If the child still experiences recurrent ear infections, an otolaryngologist can attempt to dissolve the clot by prescribing Floxin or Ciprodex. Additionally, a diluted mixture of hydrogen peroxide (equal parts distilled water and hydrogen peroxide) administered with a dropper at home can assist in dissolving the clog. Adults may prefer that their otolaryngologist attempts to pick out and remove the clog in-office, if possible.
In most cases, the ear tube will fall out on its own without issue, but after a certain point in which it is no longer needed and has not fallen out on its own, it is considered retained. Because physicians cannot fully anesthetize the eardrum, patients experience pain during the removal process. Therefore, otolaryngologists often recommend waiting it out for adults unless a circumstance dictates a need for immediate removal. To avoid a perforated eardrum in children, the physician can papoose the child and quickly pull out the tube in the clinic.
[Gopi Shah MD]
So I guess I wanted to ask you, for your clogged ear tubes after surgery, let's say it's the two year old that comes in had tubes, whether it was six weeks ago or maybe it was like six months ago, it's a tube. And one of the tubes is clogged. You got your hearing tests, let's say it's normal audio. And it's either, maybe that Type A tymp, or a small volume B tymp, tube looks good, but it's clogged.
[Ashley Agan MD]
But it looks clogged, but the hearing's normal.
[Gopi Shah MD]
But the hearing's good.
[Ashley Agan MD]
So in a kid I would probably not do much. Well, okay. It depends. So if the parent says we've been doing great, no issues, no ear infections, speech, development's fine. School is fine. Audiogram shows normal hearing and the tube just looks clogged. I’d probably leave it alone. I'd probably just say like, let's just watch it. It's not technically really giving you any issues. Right.
In an adult, well in an adult that will let me really examine and mess with their ear. I'll probably go in there and try to pick it out. Just because I feel like if it's going to be there, I'd like for it to be working, we put it in there for a reason. But, kids are a lot different. I wouldn't want to traumatize– sometimes less is more. But if there's issues, obviously you might feel differently. So if they're having recurrent ear infections and you really want that tube to be open and working, then I would want to do something. I'd probably start with just starting drops to see if it would dissolve away that clog. I would probably use just like Floxin drops, have them do it twice a day, pump the tragus to make sure the drops are really getting all the way down there. And then kind of see them back in a short amount of time to kind of see if it's working at all. I don't know. What do you do?
[Gopi Shah MD]
I agree. I think if they're asymptomatic and hearing is good, speech is good, they're not having issues with ear infections, sometimes I'll just watch them and I’ll also give the family an option. If we want to try some Floxin, Ciprodex. And you’re right, we do have to be a little more aggressive when there are issues.
Sometimes I will do a little attempt. It depends on the family and kind of what the parent is up for. Every once in a while, I'll have them try little diluted peroxide at home. So I'll have them, do you half distilled or bottled water and half peroxide. Put it in like a little cup, like a tablespoon each and then get a dropper and do like a couple of drops, three, four drops with the tragus, and then chase it with Ciprodex. And I tell the family, if the babies, if the child starts to cry, hopefully that means that the tube is open because the peroxide's going to irritate the middle ear, usually. And I might have him do that for about three to five days, unless the child starts to cry before and then just switch over to regular, Cirpodex or Floxin for another three days and then see them back and see how they look. But again, it depends, and I'll tell the family, like with the peroxide expect that they could be in a little bit of pain at home. And then see what the reaction is. And if they look at me like, I'm crazy, then we're going to just start with some Ciprodex or Floxin and see how they do. Every once in a while I'll have a family that is like, no, I want to try what you think is going to be best. And so sometimes I'll do that.
…
[Gopi Shah MD]
What do you do with the tube that just hasn't fallen out? How long do you wait to consider it a retained tube in the middle ear? Obviously we're not talking about the external ear, but middle ear.
[Ashley Agan MD]
Like it's still in the drum?
[Gopi Shah MD]
Sorry, not medialized. I meant in the drum.
[Ashley Agan MD]
So in adults, I try to just hold their hand for as long as I can and just say, it's gonna come out, because I feel like we put tubes in in the clinic all the time and it's relatively easy and adults, it's a little harder. It's a lot harder to take them out to kind of reverse that. Cause there's not a great way to anesthetize the drum. It's kind of like a 1, 2, 3 pull kind of thing, which is uncomfortable. I suppose you could always go to the operating room to take it out which I've done on a very rare occasion. So that's not super common. So, yeah, I mean, for me, it's a lot of just like, well, let's just give it some more time. Let's give it some more time. And in most, in most adults, it's not it's not causing issues. Like if it's still there and it's still open, unless, well, so like for example, you maybe have that patient, that's wanting to learn to scuba dive this summer. And they can't have that hole in their eardrum. That might be one example of a patient that you may need to speed it up. And I don't have any tricks other than I would say, probably have to just take them to the operating room and pull it out and maybe put a little paper patch or something. I don't know. What are your thoughts?
[Gopi Shah MD]
I take it out in clinic now because I papoose them. So, first of all, if it's been about two and a half to three years, that's when I start to prep the family so that it's not like, cause I just don't want them to end up the child end up with a perforation. To me that's a bigger headache. I'd rather have to go back and put a tube in cause we took it out and they're still having issues, but usually the other ear will have declared itself. Whether the eustachian tubes are working or not. And so we've gone six to nine months without having any issues in the ear or the tube has fallen out in terms of fluid infections, things like that. And the other ear that does have the tube in the drum, and now we're getting to three years, I talk to the family. Most families don't want to do the general anesthesia for this, and if we can papoose the child, it's a band-aid, a rip right, it is quick, like you said. And the kids cry, but I find that most families are okay with doing that. Now, if I can barely get the otoscope in the kid’s ear and if the mom or dad are like, I sit down and explain it to them. Like, listen, they're going to feel this, but it's a quick band-aid. And we do have to burrito them and the child is going to cry a little bit. And if the family say, no, we'd rather go to the OR then that's where we're headed. And obviously I'm not doing like a patch or something at the time of, we're just getting the tube out, if I can get another quick look to see about the hole. And if there's bleeding that I've called that a great success.
[Ashley Agan MD]
Right.
[Gopi Shah MD]
Because every once in a while, you can't even look afterwards, you just got to get them out and then I'll see them in about three months, and see where we are and things like that. So that's I’ve been doing.
[Ashley Agan MD]
And most of the time, it just heals up fine.
[Gopi Shah MD]
Yeah. Most of the times it does. And then if we have to go back and do something, cause it's now been several months or hey the perf is now causing issues with hearing or otorrhea that changes the game a little bit.
[Ashley Agan MD]
Yeah. Maybe I need to talk to my adults about the 1, 2, 3 pull.
[Gopi Shah MD]
I used to be a lot more hesitant, but, I got to talk to Dr. Mitchell, every episode. Dr. Mitchell, hello. He just does it in clinic and I'm like, well, man, if Mitchell can do it in clinic, then come on. Let's do it. So if the boss is doing it…
[Ashley Agan MD]
Yeah. I bring it up to patients as far as like we can, we can take it out, it hurts a little bit, or maybe a lot. I don't know. I haven't experienced it myself, but, I think in a lot of them, if it's not an issue, it's just like, okay, that's fine. We'll just wait. Adults, it's a lot different than kids. I feel like. And so we just give it a little bit more time and most of the time it will fall out eventually.
Listen to the Full Podcast
Earn CME
Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs. Follow the button below to claim your credits on CMEfy.
Stay Up To Date
Follow:
Subscribe:
Sign Up:
Determining the Necessity of Tube Replacement
If an ear tube has been inside of a patient’s ear for a while and the patient still experiences issues with ear infections, physicians may consider tube replacement. A common clinical scenario involves a child with bilateral ear tubes reentering the operating room because one tube has extruded. Some otolaryngologists may replace the other old tube, but others caution that removing the tube could enlarge the perforation and cause greater issues. Replacing the tube allows for freshening of the edges for epithelization, but if the perforation becomes too large, it may not be possible to place another tube at all. Before replacing an ear tube in pediatric patients, Dr. Shah often recommends sending the child to immunology to test for other conditions like primary ciliary dyskinesia.
[Ashley Agan MD]
One thing I'm into that, I was thinking of asking you earlier, the concept of a thought of like biofilms and so like a patient having a tube, let's say it's been there for a while, maybe a little over a year, longer than it should. And, the patient still has eustachian tube dysfunction, still needs a tube. Do you ever change it out? Or this is a common example, patient has had bilateral tubes. One tube has extruded. The other tube is still there. It's been there for like maybe over a year. It's fine. You're going to the OR anyway, cause you're going to put a tube in the other ear. So do you need to replace that tube with a new tube because it's an old tube?
[Gopi Shah MD]
Those are great questions. And it's funny cause those are the conversations I have with the residents, right? Like, cause this is the stuff they have to think about. Like this is actual decision-making in clinic, which sounds so simple because we think of just, oh, it's just a tube, but like it's not right. So in terms of biofilms, so I think in pediatric, especially in kids that are young with tube otorrhea, if it's just doesn't go away before I go back and switch stuff out and that kind of stuff, I might send them to immunology. I might think of something else, like sweat test, PCD, other stuff. CF doesn't have it as much in terms of OME, but, PCD would and just like what are we missing or is it just like you're kid that gets six to eight colds a year. And so, I tend not to necessarily go switch tubes out for biofilms for those reasons. And I do think that oral toilet is our best friend for that. Cause if I put a new tube in, we might still be in the same situation afterwards. Cause we're still 15 months in a daycare or not daycare, and we're just getting these. In terms of biofilms for tubes that have been sitting there for four or five years in a PCD kid that I'm going to the OR with, if the tubes are working, I kind of want to leave those alone too. I've had issues where maybe we try to put a new tube in. It gets pushed out. You know what I mean? That's happened. And so I don't always do that. I know I keep talking about my PCD kids, but that’s their issue is tubes and otorrhea. And then in the child where the left ear tube is out, the right tube is open and working, but the left ear keeps getting OME or acute OMs and it's been a year. I talk to the family, and I say, I guess my concern is I've had issues. One where if I try to replace the tube, taking a good tube out can make the perf bigger and then I can't get a tube in, that's happened. And that's really frustrating. And then the second thing is if I'm putting a new tube in, I have to remember that that perf now has been there a year plus however long that tube may be. So I don't forget about it because I don't want that child to end up with a perf after. And so I always tell him, like, if it looks good, it doesn't look like it's halfway out. It's not blocked. It's in a decent spot, meaning it's inferior or at six o'clock, whatever, it looks good. I hedge on leaving it alone and tell the family, listen, you might be frustrated with me three to six months down the line. Cause we may or may not have to go back, but maybe by then, the kid is two and a half, three, closer to four and I don't know if they were my own kid, I'd rather go back for an ear tube than end up with a perf. Perfs to me in kids are just a much bigger issue, especially under five. It's not just otorrhea, but it's hearing, speech. Whether they end up having to get a typanoplasty, postdoc care, success rate like that should be our next podcast.
[Ashley Agan MD]
Yeah.
[Gopi Shah MD]
That's kind of how I phrase it. Now, I know I have partners that routinely switch them out, just cause it's like, well, we're going to the OR, but that's just my personal preference, I think. I don’t know.
[Ashley Agan MD]
Yeah. I've had that same feeling before where you pull out a perfectly good but “old” tube, and then when you put the replacement tube in, that hole, it's too big. Right? It's big. And so you're like maybe putting a piece of gel foam or something to just kinda give you some extra, something to hold it in place. Because it just looks like it's just sitting there kind of on the edge of a big perf.
[Gopi Shah MD]
When you take a tube out, there might be a little wax on the drum. And so when you take the tube out, some of the drum comes with you or it’s just the bottom, the medial end of it, kind of. And I like that the fact that when you pull a tube out, it refreshes the edges, right? Like the act of pulling it out kind of is that sort of freshening it up for epithelialization, but man, and then you end up with something bigger. Can't get anything in. And I've had kids that end up with perfs. I'm just like, ugh, gosh, why? So I don't know. That's just my personal, opinion on it.
[Ashley Agan MD]
Yeah, but you're right. It's a conversation to have with the family and a lot of medicine is that shared decision-making and depending on the kid maybe, the risk of a second anesthesia event in three months is really a big deal.
Treating Blood Clots and Mucus from Ear Tube Surgery
Sometimes patients return to the clinic with complications after ear tube surgery, including blockage from blood clots or thick mucus. A blood clots in ear after ear tube surgery is usually present at the first post-op follow-up visit and can usually be dissolved with a hydrogen peroxide solution of equal parts peroxide and distilled water. While any patient can get thick mucus clogs with ear tubes, they are most common in children with primary ciliary dyskinesia. To avoid repeated visits to the office, parents can suction their child’s ear at home with a blue bulb syringe and the diluted peroxide solution. This thins the mucus and allows the bulb to suction some of it out. Frequency may vary from once per week up to a few times per week. When working with the adult population, the otolaryngologist can often pick out the clot or clog in-office after softening it with peroxide. Placing a few drops of baby oil in the ear can assist in cases in which the wax is especially hard.
[Gopi Shah MD]
So in terms of the blood clot from the ear tube surgery, that's definitely, I think where the peroxide probably is gonna give you the most bang for your buck. And that's going to be the kid that is gonna be your first post-op follow-up, although every once in a while you might see it a little bit later on down the line. In terms of really thick mucus, it makes me think of my primary ciliary dyskinesia kids or the kids that are under two and they're still in daycare or there's just 15 months and we're in the middle of January. They're going to keep getting those six to eight colds a year and it's like, well, dang, we just had ottorhea three weeks ago, two weeks ago, like it's just constant. And, I don't see it and I'm not necessarily worried about cholesteatoma at that time. I'm worried about more of these colds that keep happening. For my PCD kids, I will tell them to routinely do a little diluted peroxide and get one of those blue bulb syringes, the baby ones that flare out. I'll have them then kind of suction their own ear. Because the diluted peroxide kind of thins it, cause it's thick and then they can get one of those blue bulb syringes. It's going to flare out, so it's not like they can shove it too deep to their ears, but I'll have them mark from the tip about seven millimeters or so, and then gently squeeze the bulb, put it by the ear and suck it out. Cause otherwise those kids are constantly in my clinic, getting papoosed, especially the three to five-year age. And at a certain point, they're not gonna let you even look in their ears. So this is something that maybe would avoid that. Because overall the thick stuff's gone and then they can get the drops in. And so sometimes I'll have them do that a couple of nights a week, or even once a week, depending on how much they get, because it's just oral toilet for that population. And so those are the two that I tend to be a little bit more. And then if it's mucoid thick stuff that's blocked, I'll talk to the family. Every once in a while, if it looks like it's worth papoosing and suctioning, I might do that. Versus trying and some drops. If I can see the tube and think the drops will go in and have them come back. And if that still didn't do it, maybe try to see if it's worth, if it's loose enough to section out the second time around. In terms of a pick and trying to do wax in the lumen. That sounds lovely. It just depends on the kid and what I think is actually feasible, but that's not a part of my routine practice. I'd say sometimes. They cast too, right. Like you've taken the tube out and it's a whole cast that's like two millimeters or something, which sounds kind of small, but it isn't, and it's hard.
[Ashley Agan MD]
Yeah, I feel like in adults, I feel like that's kind of what I'm picking out a lot is like this little cast, some old drainage or mucus or something that has kind of just, occupied the lumen long enough that it just stuck there. And usually I can take like a little rosen or something and just kind of slowly pick it out.
[Gopi Shah MD]
Do you peroxide and let it sit and soften it and then section and pick or does it tend to kind of work its way out?
[Ashley Agan MD]
It tends to work its way out. I don't usually put anything in there. I mean, it's all patient dependent too. Some patients just really don't tolerate you kind of flicking, because you're going to touch the tube a little bit, but those tubes, I think that that silicone material doesn't adhere to it very well. So it tends to kind of come out pretty, like if you can kind of get an edge on it and gently just tease it out, it'll slide out. But sometimes if it's like wax or something, that's been pushed down there with a Q-tip or something like that, sometimes I'll do like some baby oil. But again, I like don't want that going into the middle ear. So, it's only if the tube is like really clogged and the wax is hard enough that I'm not really able to get it out with other instruments and I just really need to soften it up. Baby oil's really good for that.
[Gopi Shah MD]
So they're in the clinic, in your chair, you do a couple of drops of baby oil. Let them sit for a little bit.
[Ashley Agan MD]
Yeah. And then just kinda try to section it out or tease it out. And then, but I've pulled out a tube before once or twice too, that happens.
[Gopi Shah MD]
I guess in your clinic, in adult, you can just put a new one in.
[Ashley Agan MD]
Exactly that. Yeah. That's what I've done if it comes out, it's like, oh, whoops. Yeah. Can we get another tube?
[Gopi Shah MD]
Yeah. And kids like, because most of the time, I mean there are people that do tubes in kids in the office with the, what is it called? The hummingbird. I always want to call it the butterfly, the hummingbird. But for my practice, I usually end up going to the OR. So the question is who, when, and why are we going? Because if we just put the tube in, I always, it always kind of makes me so sad that we're back three or four months later because it's clogged and they're still having ear infections and it's OME and it requires orals or affecting hearing or speech. And so that doesn't happen often, but when it does, I'm always like, ughh.
Treating Tube Otorrhea
To treat tube otorrhea, otolaryngologists often prescribe Ciprodex ear drops as the first line treatment. This antibiotic clears up the infection a significant portion of the time and is relatively easy to administer. To maximize the effectiveness, physicians can instruct their patients to pump the tragus by placing a finger on the tracheal cartilage and repeatedly pushing and then releasing. This allows the drops to permeate down into the drum and through the ear tube. In some cases, the Ciprodex causes clumping and can crystallize in the ear, perpetuating the clog.
If there is significant otorrhea, patients may have to have their ear suctioned prior to beginning treatment with Ciprodex. Pediatric otolaryngologists often papoose children under five in order to suction the ear. When treating this age group, starting with a five suction generally works best for the lateral canal, unless the mucus is too thick, in which case, a seven suction can be used to start before transitioning to the five.
If Ciprodex fails to treat the tube otorrhea, patients may need to return to the office for more frequent suctioning to keep up with the excess drainage. Patients with bad allergies or chronic sinusitis may find relief for their tube otorrhea with a steroid drop, such as dexamethasone or Pred Forte. Sometimes administering a puff of mastoid powder can assist in absorbing the drainage, but in some instances the powder may instead perpetuate a clog.
[Gopi Shah MD]
All right. What do you do about tube otorrhea?
[Ashley Agan MD]
Ciprodex is probably the first, most common, that's so common that even when patients call most of the time, the nurses will just check and be like, I'm sending in some Ciprodex and I'll be like, yep, that sounds great. Let's try that first. So I would say, I don't know, what percentage would you say? A significant part of the time that's going to clear it up and help. And I always tell patients to do pumping the tragus. So putting a finger on the tracheal cartilage and kind of pushing in and letting go, pushing in and letting go, to try to drive those drops down, to the drum and through the tube. I know the otologist have always told me that's important. And so that's kind of my first go-to, if they're in the clinic, I like to try to section as much as I can. Because if there is a bunch of really thick stuff down there maybe the drops can't even get through the tube and where you want them to go. So getting it cleaned out as much as you can to allow for the drops to get there, I think it can be helpful too.
[Gopi Shah MD]
So if I can see that ear tube, and there's just a little bit of drainage on the drum I'll just have him start Ciprodex. This is if I've seen them in clinic. Obviously, if I can't see the tube at all, because there's so much otorrhea we're going to section and it's going to require papoose. And I always tell families, at the time of surgery before we do the tubes and that one of the things, especially in kids under two, otorrhea and having to be papoosed and getting suctioned, that might be on more than one occasion sometimes, is a very real part of the process.
[Ashley Agan MD]
So you prepare them that prepare them for that.
[Gopi Shah MD]
Yeah. Because as a parent, even if it's five minutes, we’re burrito-ing their kid and it's loud, the child is screaming most of the time. Yeah. And you may have to do it more than once. It may not resolve the first time around. But usually, that's kind of when I decide to section. Most of my kids that are primary ciliary dyskinesia, I just section them every time, their ears, depending on the age and their tolerability. So I have a handful of younger PCD kids that I just can't do it every time because they're not gonna let me look in their ears. And those are the ones, as long as I can see the tube and their audios, are good, even if there's a little fluid, just kind of by the tube, that's actually a good outcome.
[Ashley Agan MD]
Because the fluid is coming out.
[Gopi Shah MD]
And then the kid, the patients that are a little bit older, who I've known now for a couple of years, they come in, they understand what their pathophysiology, why, and what's happening. There are a lot more amenable to it and they're used to it now.
[Ashley Agan MD]
What size suction do you use?
[Gopi Shah MD]
In my kids that are under five, under three to three to five, I use the five section usually, for the lateral canal. Unless it's just so thick, then I have to start with a seven in the lateral canal. But what I like with the five is then I don't have to necessarily switch over to a three. I can at least get it so I can section, see my tube, see the lumen and get anything thick. I mean, they're not gonna let me get in with a three, we're just trying to make sure the drops go in. For my older kids, again, if it's thick, I might have to start out with a seven for that lateral canal and then go to the five usually, so that's kind of how I do it.
[Ashley Agan MD]
Do you ever put anything in there, in clinic, to thin things out before you section?
[Gopi Shah MD]
No, not necessarily, unless I'm worried the lumen is clogged.
[Ashley Agan MD]
Yeah. I mean, they're papoosed and you're on the clock and it's like, all right.
[Gopi Shah MD]
Yeah. Not my older kids though. I can’t papoose, once they're like seven, eight years old… It's like under five, you might be able to.
…
[Gopi Shah MD]
Okay. So let's say they come in and you've sectioned their ears. You tried Ciprodex for about a week, but they're still having otorrhea.
[Ashley Agan MD]
So we'll take a look. Sometimes with Ciprodex, you can get some clumping, the medication will crystallize and you'll get this like white clumping down on the tube or on the drum that sometimes will continue to clog your tube. So you have to be mindful of that. So you may have to clear that under the microscope in the office.
If they're continuing to have just nasty drainage, despite being on Ciprodex sometimes I will have them come back more frequently to where I can suction them more often because the thought being like, okay, maybe the medication is not able to get through the tube and into the ear to treat that mucosa because there's just so much drainage and they just need to have more suctioning more often. But I've never tried the blue bulb trick that you're talking about with your kids. So maybe I’ll start trying that in adults and see if that helps just to give them some, a way to kind of clear some of that so that the drops can get down to the drum and through the tube.
[Gopi Shah MD]
I think that's only really helpful for that thick lateral stuff. Yeah. But at least it’s something.
[Ashley Agan MD]
It's something. Yeah, for sure. Especially if patients have drainage, that's coming out of their ear onto the pillow like, if you're dealing with like a large volume. Let me think. Sometimes I'll switch up the drops. In a patient who has really bad allergies or maybe as like a chronic sinusitis patient, sometimes I will switch to just a steroid drop, like dexamethasone or a Pred Forte, with the idea that the middle ear is like an accessory sinus. And so in the same way that we use Flonase or nasonex or some sort of nasal steroid in the sinuses, you're trying to apply some steroid into that middle ear space. But again, the tube needs to be open and working so that that medication can get in there and treat those surfaces. Sometimes I'll use some mastoid powder. You have to be careful with that because it can clog the tube too. But I have had a little bit of success doing a little bit of puff of that in there, if the ears just really wet and really draining a lot and you need something to kind of help absorb some of that, I don’t know, what are your thoughts?
[Gopi Shah MD]
Yeah. I’ll probably see them back a little bit closer and follow up compared to the clogged ear tube. Say two to three weeks. And a lot of times, if it's still significant, otorrhea that patient's going to be back within about a week or so. Or sooner rather than later, cause they can see it, right? And I'll section again. And I might try some mastoid powder at that point, but you're right, it's different than just like a perf that keeps draining or a otitis externa that just won't dry up. And so, you're right, that can get clumpy and it can clog the tube as well. And so sometimes I'll do the mastoid powder and then maybe let that sit at home for a couple of days and maybe even restart something like Ciprodex or Floxin a couple of days later, like maybe two, three days later to kind of clear some of that.
And, I don't do this a lot, but it had a handful of kids where, we've been doing this now for four to six weeks and it's just still, and every once in a while I might add like augmentin or something. I know we're always like tell the pediatricians, not just do oral antibiotics when you have tubes. But every once in a while you've already maybe brought them into clinic, papoosed and suctioned two or three times, and we're still doing this. And it's catching the one virus after, you know what I mean? Maybe they caught something else three weeks later and here we are again. And so every once in a while, do we have to do that. It's not common, but something that I'm like, well, I guess what else can we try? I like the steroid drop. I haven't done that as much in my kids, but maybe my older ones where it's more allergy related. Makes sense.
Podcast Contributors
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Cite This Podcast
BackTable, LLC (Producer). (2022, June 7). Ep. 61 – The Ins and Outs of Ear Tubes [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Podcasts
Articles
No OR Time, No Problem: In-Office Pediatric Ear Tube Placement with the Tula System
How to Integrate In-Office Ear Tube Placement into Your Pediatric ENT Practice