After the specialist confirms that fluid is present behind both eardrums, further medical treatment is often advised. If the fluid has been present for over 12 weeks, surgical drainage of the fluid is often indicated.
The decision to perform surgery should be based on the response to medical treatment, the degree of hearing loss and the appearance of the eardrum itself under the surgical microscope.
Surgery which drains fluid involves a small incision in the eardrum so that the fluid can be gently removed and a tube can be inserted.
The procedure medically termed a myringotomy and tubes, or tympanostomy and tubes are performed on children under general anaesthesia. Surgery is performed on an ambulatory or same-day surgery basis.
Parents often ask why the fluid cannot be drained without inserting a tube. The need for the tube insertion is because the eardrum incision generally heals very rapidly. As soon as the eardrum heals, fluid will re-accumulate. Tubes were first introduced because of this very problem. Most tubes will gradually be rejected by the ear and work their way out of the eardrum. As they come out, the eardrum seals behind the tube. Tubes will last four to six months in the eardrum before they come out. Occasionally, the eardrum does not heal completely when the tube comes out.
The majority of children treated with tubes do not require further surgery. They may have ear infections in the future, but most will clear up with medical treatment. Some children are very prone to ear infections and have a tendency to accumulate fluid after each infection.
In addition to the insertion of a tube, a careful search for underlying causes of Eustachian tube function should be sought, particularly in a child who has recurrent infections and requires a second set of tubes.