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This one is about: Ear Tubes
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Most cleft-born children will, at some time, experience some problem with otitis media (fluid-caused pressure behind the eardrum) and resulting ear infections. This is due to the fact that the Eustachian tubes of Cleft-affected children are often affected by the deformity and are not effective in relieving the pressure. A common treatment for this condition is myringotomy with tubes.
Myringotomy is a minor surgery done under general anesthesia during which the surgeon makes tiny incisions in the eardrum. To make those incisions more effective, tiny ear tubes are most often inserted at the time of the myringotomy. This is called, "Myringotomy with tubes".
The tubes most typically inserted are made of a rigid plastic or metal material. They remain in the ear for anywhere between a few months to a year or more. Eventually the standard tube will fall out by itself. Hopefully by that time your child's Eustachian tubes will function normally. If they are not yet functioning and pressure and infections continue to persist, another set of tubes may replace the first.
Some children are subjected to set after set of tubes and still have persistent ear infections. When this happens, the surgeon may opt to insert another, more permanent type of tube instead. While the more permanent tube will require that they eventually be surgically removed, the use of those tubes will reduce the number of multiple sets and therefore reduce the eventual scarring on the ear drum.
The more permanent tubes are called, "T-tubes". They are made of flexible Silastic, a very soft synthetic rubber. They are shaped like a letter T. With the wings of the "T" folded flat, they are inserted through the eardrum during surgery. They then pop into place, opening the wings of the "T" against the inside of the eardrum. Like an open umbrella, they are held securely in position behind the eardrum until the doctor chooses to take them out.
Tube after-care, regardless of the type of tube used, consists of protecting the ears from being flooded with water. Since T-tubes are extend further into the ear canal than standard tubes, extra care is needed to keep from disturbing them. Swabs may not be used to clean the ear without the permission of the ENT. Also, standard ear plugs used to keep water out of the ears may bump the T-tube and be uncomfortable. Most children with standard ear tubes have no problem wearing ear plugs.
By the age of three or four, most children will outgrow the need for tubes, as their Eustachian tubes will reach a point of maturation at which they will begin to function more normally. There are some children who have recurring ear infections into their school-aged years and a decided minority will suffer with persistent ear infections into adulthood.
While there has been some criticism concerning the "over-use" of ear tubes among young children, it is important to note that cleft-affected children have an anatomic deformity that will not allow the ears to function normally. At the least recurring ear infections and otitis media is painful for the child and will interfere with the child's ability to hear. At the worst, unchecked otitis media and ear infections can lead to more severe infections of the brain or permanent hearing loss.