Pressure Equalizing Tubes

What Are Pressure Equalizing Tubes?

Pressure equalizing tubes (PETs) are commonly called ear tubes. They are small medical implants that are placed though the ear drum to allow gas exchange between the middle ear (area behind the ear drum) and the ear canal. They are called PETs because they equalize the pressure between the middle ear and the outside world. They are made of a variety of different plastics and metals including titanium. They come in different shapes and sizes depending on their intended use.

When Are PETS Indicated?

PETs are indicated in ears with abnormal ventilation to relieve the symptoms and complications associated with abnormal middle ear pressure.

In children, poor ventilation due to Eustachian tube dysfunction is very common. This results in recurrent ear infections, trapping of fluid behind the ear drum, hearing loss, and damage to the middle ear structures (ear drum, ossicles, mucosa). PETs prevent these complications in patients with Eustachian tube dysfunction. Eustachian tube dysfunction can also occur in adults less frequently.

In addition to preventing infections, PETs may also be placed to treat more severe infections. Complications of acute ear infections include facial paralysis, mastoiditis, labyrinthitis (nerve hearing loss and dizziness), and meningitis (brain infection). PETs are used as part of the treatment strategy when these situations occur.

In adults who travel frequently, a small percentage suffer from barotrauma when flying. When the plane descends, severe pain and hearing loss may occur if the traveler cannot properly clear their ears. In these patients, ear tubes are placed prior to flying to prevent these symptoms.

PETs may also be used in a variety of other special situations. Sometimes steroids may need to be given over a long period of time. To avoid the complications of oral steroid administration, a PET may be placed and the patient can give themselves a steroid ear drop at home. PETs may also be used for patients undergoing hyperbaric oxygen therapy, or for patients with rare diseases like patulous Eustachian tube or superior semicircular canal dehiscence.

How Are PETS Inserted?

For most adults, PETs are inserted in the office. Your doctor will have you lay on your side and turn your head away from the ear receiving the tube. A drop of phenol will be used to numb your ear drum. A tiny scalpel called a myringotomy knife will be used to make a small incision in the numbed ear drum. The tube is then placed into the incision. PETs have flanges that lock them into place once they are inserted.

In children, PETs are best placed in the operating room under general anesthesia. The ear drum and middle ear structures are very delicate and placement of PETs requires precision. Children are generally too uncooperative to undergo PET placement while awake.

What Should I Expect After PET Placement?

A dull ear ache may occur a few hours after the tube is placed. This can be treated with OTC Tylenol or ibuprofen. Drainage is common for 1-2 days after the tube is placed.

PETs will eventually come out of the ear drum. The length of time varies with the type of tube. Most last around 1 year. Your doctor will check on the tube once or twice a year after it is placed. Occasionally drainage will occur. This is simply treated with a few days of antibiotic ear drops in most cases. After the tube comes out, the ear drum heals the opening. A new PET may be needed. Rarely, a perforation in the ear drum remains. Surgical repair can be achieved if the patient and doctor wish.