Tympanostomy or Pressure Equalization Tubes (PET) are tubes that are placed into the eardrum to allow fluid and pressure to escape into the ear canal. The PET essentially bypasses the natural pressure valve of the middle ear called the eustachian tube. This small tube connects the middle ear with the back of the nose and is lined with the same lining that is found in the inside of the nose. Often patients with nasal problems may present with ear issues such as fluid or problems with flight because of this relationship.  Dr. Pasha considers the eustachian tube a part of the nose and often ear problems are actually nasal issues. PETs are a temporary solution for eustachian tube dysfunction.    

Dr. Pasha has placed thousands of PETs in the office or during brief general anesthesia in the operating room. An operating microscope is used to look in the ear canal. A small incision is placed in the eardrum, fluid is suctioned out, and the tube is placed into the hole.

FAQ about Pressure Equalization Tubes

How long does the surgery take and how much work or school will I miss?

Dr. Pasha typically takes 5-15 minutes to complete the surgery. Aside from the day of surgery, no other time off is required. In most cases the recovery is minimal with little pain.

How long do PETs stay in the eardrum?

Pressure Equalization Tubes usually come out on their own as the eardrum rejects the tube. For most patients, the tubes last an average duration between 6-24 months. The smaller tubes generally stay in a shorter period of time (6 months). Some tubes with large inner flanges stay in a long period of time (2-3 years).

What are the potential complications of PETs?

Generally speaking, PET placement is common, simple, and a safe procedure that rarely results in serious complications. Here are some potential complications:

  • Early extrusion: Occasionally, tubes may come out earlier than expected. Thin eardrums have a higher risk of early extrusion. In this case, PET may have to be replaced.
  • Persistent drainage: Despite the benefit of aerating the middle ear. Ear infections may recur. When an infection occurs the ear will drain since the tube allows the infection to escape out of the ear. If this occurs, you or your child will require antibiotic eardrops instead of oral (by-mouth) antibiotics.
  • Eardrum Perforation: Once the tube comes out, some eardrums may not close or heal completely. Long-lasting tubes (large tubes) and thinned eardrums have a much higher rate of persistent perforation (up to 10%). If this occurs, a second minor procedure may be required to close the hole.
  • Persistent PET: Uncommonly, a PET may persist in the eardrum for years. In this case, the tube may be removed.
  • Hearing Loss: Although extremely rare, PET may damage the bone of hearing in the middle ear. If this occurs, repair of the bones may be required.
  • Tympanosclerosis: Tympanosclerosis is scarring of the eardrum. For the vast majority of patients, this has no clinical or hearing significance.
  • Risk from Anesthesia: Some PETs are placed under masked general anesthesia (you will be asleep). Although extremely rare, complications may occur from the medicines and the anesthesia procedure.
What are the benefits of PETs?

PETs have several benefits to the patient.

After PET placement hearing and pressure is often immediately restored or improved.

The aeration of the middle ear reduces the likelihood of recurrent otitis media (i.e. a group of inflammatory diseases of the middle ear).

Infections become more reliably detected since they present simply with a draining ear. When infections do occur they are less painful and the infection may be managed with ear drops alone instead of antibiotics by mouth.

What happens to the hole in the eardrum after the PET comes out?

In most cases the hole closes after a few weeks to months. If there are continued ear infections, the hole may persist to allow the fluid to drain. Occasionally, the hole does not close and another procedure may be required to repair the hole.

How do you take care of PETs after surgery?

PETs require little maintenance once placed in the eardrum. For a few days after the procedure you may be instructed to use eardrops. Dr. Pasha may ask you to keep your ear dry (use ear plugs when swimming). Diving deeper underwater, or swimming in (dirtier) lakes and rivers is more likely to cause infections.

You should also follow-up every 3-6 months to have your ears examined and make sure the tube is functional.

What about flying after PETs?

A big advantage of PETs is that you do not have to “pop” your ears during flight. Because the PET by-passes the Eustachian tube, pressure can not build up behind the eardrum. Flying is much easier with PETs. In fact, Dr. Pasha often places PET in airline attendants and pilots who have trouble with their ears during flight.

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