Three weeks ago I had no idea adults got tubes in their
ears. In the last three weeks I have spent countless hours souring the Internet
for information on tubes in adults. The most I have been able to find is mentions
that yes, adults get tubes too; adult tubes are much less common and that
adults don’t have to have general anesthesia. I have been unable to find
anything that describes what to expect or follow-up care. Therefore, I have
decided to share my experiences and the many things I have learned. My
experiences may not be the same as yours and they may not even been typical (especially
since I live in bush Alaska which means I cannot drive in or out of my community).
Last January I had pneumonia. Last May I had bronchitis
together with a sinus infection and allergies. I went to the clinic in my community
on Thursday and Monday I flew to Anchorage for the summer. That plane flight
was one of the most painful flights of my life. In early June I flew from
Anchorage to Los Angeles and six days later from Los Angeles to Sydney Australia.
While I was in Australia I flew from Sydney to Cairns before flying back to
Anchorage via Los Angeles (and Seattle). I’m telling you all of this because,
while it hasn’t been confirmed, I believe my ear problems are probably the result
of barotrauma. Barotrauma refers to injuries caused by increased air or water
pressure, most commonly the result of flying or scuba diving. Basically
barotrauma is the result of a vacuum being created in the middle ear which
pulls the eardrum inward (Harvard Health).
Shortly after my return from Australia I was having
tremendous trouble with my ears, but was avoiding seeking medical care (not the
wisest choice). Then one evening I blew my nose. I felt a pop in my ears and
could no longer stand up. I was standing directly in front of a bed and dropped
straight onto the bed. The next morning I went to an urgent care clinic. The
nurse practitioner instructed me to use a nasal rinse and prescribed a steroid.
She also suggested that I see an ENT (which stands for Ears Nose and Throat,
the official term for this type of doctor is an otolaryngologist). She didn’t
seem to make it sound that important and so I didn’t worry about it too much.
Three weeks later I went back because the pain in my ears had not gone away.
One of the things she clarified was that it hadn’t ever gone away rather than
come back.
On my return visit, the nurse practitioner said it was
really important that I see an ENT. She also prescribed a stronger steroid (high
dose prednisone) and a strong antibiotic because she figured since my ears had
been bothered for this long, there must be an infection inside. Additionally,
she added an additional allergy medicine to the three I was already taking.
At this point, I was concerned about my need to see an ENT
because it was about time for me to return to my village. We don’t have an ENT
here. Luckily, I was able to get in with an ENT the following Monday.
When I saw the ENT I was still on both the prednisone and
the antibiotic. He added a second nasal spray to help dry out my sinuses and my
ears. This was the first time I heard an important diagnosis, retracted ear
drums. A retracted ear drum is where the ear drum gets pulled in towards the
middle ear. This of course can (and frequently is) the result of the vacuum
created by the barotrauma (that vacuum frequently fills with fluid.
I flew home on August 11th and while the pain
wasn’t as great as it had been when I left in Anchorage it was not good. I went
through a lot of pain with it increasing over time. By the end of September I
was reaching the end of my rope. I scheduled an ENT appointment, purchased plane
tickets and put in a leave request. Unfortunately, before I was able to go to
Anchorage I got a really bad case of strep throat. While I was in the clinic
for the strep throat the medical professional I saw (I’m not using titles here
because I live in a very small community. The title can give away too much
information and I want to respect others privacy) looked at my ears and was
pretty horrified. I asked her to describe what she saw and she said, “They’re
not right. They’re not the right color and they’re retracted. It looks like they
may be thickened too.” She then told me I might need tubes. “They do tubes in
adults?” “Yes,” she assured me, “they most certainly due.”
I finished the antibiotic for the strep throat (my ears got
SO much more painful when I had strep too) on Friday and saw the ENT on Monday.
I had been concerned that he wouldn’t take how bothersome my ears were
seriously (and considering how painful the flights to Anchorage for the
appointments were I really didn’t want to have to endure that pain back to my
home and of course back yet again to Anchorage). Thankfully, the ENT took me
very seriously. He ordered a CT of my temporal bones. He wanted it done on
Tuesday morning so that we could meet again Tuesday afternoon, but Providence
Imaging couldn’t get me in until 2:40 pm on Tuesday. The doctor said he would
see me at 4:30 Tuesday afternoon. The asked the imaging center to rush the
results and instructed me to pick up a CD of the images myself.
I met with the ENT around 4:45 Tuesday afternoon after
hearing the nurse on the phone requesting the imaging center send over the
radiologist report. I can’t remember all of the numerous things we discussed
that my doctor had been concerned with or that the report otherwise stated
weren’t a problem. I do remember that the big one was he was concerned about
the mastoid bone. Apparently, this bone has a honeycomb-like structure which
could mean there was an infection within the bone. There was also no fluid in
my middle ear and also no brain tumor between my ears (I hadn’t even though
about that possibility – much- but it was a relief to know that wasn’t an issue).
My eustachian tube didn’t show a problem, but CT scans can’t show eustachian
tubes very clearly so there may still be an issue with my eustachian tube.
Children have very narrow and more horizontal eustachian tubes and this is why
they frequently need tubes until their eustachian tubes grow. As an adult, my
eustachian tube is, of course, no longer growing.
The CT scans were both good news and bad news. They excluded
a lot of potentially awful concerns, but they didn’t give an explanation to the
retracted ear drums (and the accompanying pain). Thus, we were left with simply
treating the symptoms. My ENT and I discussed the pros and cons. The cons are
pretty small mostly just the potential that my ear drum didn’t close after the
tubes came out. I asked about the length of time the tubes would be in because
children’s tubes usually get pushed out by their growth. He told me that in
adults the tubes are usually in for 12-24 months (children are usually 6-12
months). I asked what would happen if they came out and the pain returned
because we hadn’t actually treated the cause, just the symptom. He told me that
we would then put in longer tubes. The longer tubes are more likely to cause
the eardrum to not close because they sit differently, but they also stay in
longer. While I have the tubes in I would be allowed to swim in pools, but not
in lakes, rivers or the ocean.
I decided that tubes
seemed the best option and asked if we would do one ear or two. My right ear
was worse than my left and my doctor told me that if I lived anywhere on the
road system he would only do the right ear and if that wasn’t sufficient to end
my pain, then do the left tube. However, since I don’t live on the road system
and my coming back in would be very difficult (I had to take off 3.5 days for
this trip, plus the cost of the plane tickets) he might do two. However, he said
he’d paint my ear drum with a local anesthetic, but I’d still be able to hear.
He said that there is a scratching noise that really bothers a lot of people. I
felt that it wouldn’t be an issue for me and so we decided that he would seek
preauthorization from my health insurance for both ears. Then he would do the
right ear first. If I found it to be “a piece of cake” we would go on and do
the left ear. Seeing as the appointment didn’t start until after 4:30 in the
afternoon it was too late to seek preauthorization on Tuesday and my flight
home left at 6 am on Thursday. Thus, we tentatively scheduled the procedure for
around 9, or 9:30 on Wednesday. The doctor had an operation in the O.R. first
and I had a dentist appointment. The front office staff would call for the
preauthorization first thing in the morning and then call me.
I was still at the dentist when she called, but when my appointment
finished I called her back and while the doctor wasn’t back from the O.R. yet
it was decided I would go ahead and come straight to the office.
While it took me only five minutes to drive from my dentist’s
office to my ENT’s office he must have arrived in between because I didn’t see
him arrive and I was called back just minutes after my arrival.
The nurse took me back and we went over the procedure including
an interesting issue the doctor had failed to mention the day before. She was
in the process of explaining that the tubes would affect how I heard tones when
the doctor came in. The three of us continued to discuss the procedure until all
of my questions were answered and then I signed the consent form (complete with
the time – 9:48 am). The nurse told me that usually the most painful part was
the anesthetic. She said there would probably be about 20 seconds of pain.
The nurse left the room and the doctor raised my chair and
then reclined it nearly flat. He had me look to the left while he worked over
my right shoulder. I really didn’t feel the anesthetic go on my eardrum. The
doctor and I talked about random things related to what I do and the time he
had spent living in China and so forth. While we were talking I could feel pressure
on my ear and heard some noises. The biggest noise was apparently the tube
being inserted. He had previously described it as a scratching sound, but it
reminded me more of the noise of two plastic tubes when you try to slide one
inside the other. I think because I didn’t hear what I considered a scratching
noise I was taken by surprise when he said, “you’re a Rockstar. I’m finished.” “That’s
it?” “Yes,” he replied, “that’s it.”
The right ear had been so easy that we immediately went to
do the left ear. As the doctor was starting on the left ear I asked him if he’d
put anything else in my right ear besides the tube because I couldn’t hear very
well (and it really felt like he’d put a cotton ball in the outer ear). He told
me he hadn’t but the reduced hearing was probably for three reasons: 1) my
eardrum was anesthetized, 2) I had just had a small incision cut in my eardrum
(this procedure by the was is called a myringotomy and the tubes are called
tympanostomy tube) and 3) my eardrum had been retracted for so long it would
take time for my brain to readjust to my eardrum being in the neutral position.
The left ear was a little more difficult. Apparently, my ear
canals are significantly different shapes. This difference is not noticeable
when examining the ear but is very apparent when trying to perform this
surgery. As a result of the angle from which he had to work, the doctor had
quite a bit of difficulty getting the tube in. The instrument hit the bone on
the side of the ear several times and since this part wasn’t anesthetized it
was rather painful. There was also a lot more of the pushing sound than I heard
with the right ear. Nonetheless, if the right ear had been as difficult as the left,
I probably would have still had him do both ears. I texted my aunt from the
parking lot after I left. The time of the text was 10:09 am. Since I hadn’t
been under general anesthesia I was clear to drive. I was also clear to fly at
6 am the following morning.
On Friday afternoon, I called the doctor’s office because I was
experiencing decreased hearing. Most people have fluid behind their ears and so
during the operation the fluid is suctioned out and they hear better. I hadn’t
had any fluid and was struggling to hear my students. With my high schoolers
the problem was simply with hearing them, but with the pre-K/kindergarten P.E.
class I had significant trouble understanding them. I didn’t report this part
to the nurse at my doctor’s office because I figured this was directly related
to the pitch changes I had been told to expect. At the beginning of the year I
had had a terrible time understanding them and it was like I had regressed, but
my high schoolers were a different matter. I simply couldn’t hear them. One
student had to repeat a statement three times before I heard it. When I asked
her another question, I didn’t even bother asking her to repeat it. She was so
frustrated from the first instance that I just read her lips without ever actually
hearing the answer. This worried me and so I called the doctor’s office.
The nurse told me that during the myringotomy the doctor
added antibiotic ear drops. She asked if I heard popping and cracking sounds.
When I said I did she was certain that that was in fact the issue. She told me
to give it until Monday. If I was having hearing issues the next step would be
to get a hearing test, but the nearest audiologist would be in Fairbanks and it
didn’t seem worth it for me have to go that far for a hearing test. She also
felt it probably wasn’t necessary and I felt it was pointless because a hearing
test won’t correct the problem. I did ask her if there was anything I could do
to help get the fluid out of my ears. She told me I could plug my nose and blow
like you do to pop your ears. She informed me that my ears wouldn’t pop,
something I knew very well to be true since I had taken two flights to get back
home. She also told me that the more cracking and popping sounds I heard while
doing this, the better.
Shortly after my phone call I tried this. It was the weirdest
feeling and sound. I could hear cracking and popping sounds, but I could also
hear the air coming out my ears. It sounded a lot like the high-pitch sound you
hear when a car window is just barely open and the car is moving at high speed.
On Sunday when I was at church I was struggling to hear and
so I tried this ear clearing method several times. I worked, and I was able to
hear a lot better. However, I found out on Monday that everyone in my row at
church could hear it. I was told it sounded like my ears were blowing bubbles.
By Monday I could no longer hear any cracking and popping
sounds while blowing, but could tell my hearing was still affected. I was going
to call the doctor’s office during my prep which is after lunch. Unfortunately,
while I was sweeping after lunch (I clean up the lunch tables and sweep in exchange
for lunch and we have the best school lunches I have ever seen) when I suddenly
got really dizzy. Not dizzy like the room was spinning, but like I couldn’t
stand up. I leaned against my broom and heard a coworker asking if I was okay. I
didn’t answer. I leaned against the bleachers and used them to sink to the
ground. I don’t believe I answered my coworkers questions. One went and got the
principal. I answered his questions with shrugs. I didn’t feel I could move my
head. One coworker got my hoodie from my classroom. The principal walked me
towards the front doors. He left me standing at a corner near the entrance to
go and get his coat. I held onto the corner for dear life. Unfortunately, a bus
had just arrived and students were streaming past me into the building. So much
for being inconspicuous. As the principal went to get his truck to drive me to
the clinic (a 3 minute walk away) the superintendent pulled up so we rode with
him. At the clinic the principal walked me in and I was leaning against the
wall when the first person came out. It was still lunchtime and the clinic was
mostly unstaffed. By the time the doctor had arrived I was in the room, had
been examined and was feeling much better. I learned in the examination that my
tubes looked good and there was no sign of fluid in my ears. The doctor told me
that the hearing problems should go away with time. Because my eardrum was
retracted for so long it was stretched out and would have to tightened. My
hearing problems were concerned while in the course of doing things part of
what she said was said from behind and I was unable to make out what she said.
She did tell me, “well if you’re hearing doesn’t improve at least you already
know sign language.” That was a joke I wasn’t really ready for (and of course
not totally a joke. She also knows sign language and when I said, “but I don’t
want to have to rely on sign language, “ she replied that she didn’t want to either)
The doctor determined that the dizzy spell was the result of
whatever underlying condition has caused the need for the tubes rather than the
tubes themselves. She taught me that the inner ear is responsible for not only your
balance (which I knew), but actually you’re entire orientation in space
including which way is up. Since this incident was similar to the one in the
summer where my ears popped she said that anytime your ears pop it can affect
your inner ear. If it were to happen again I should just lay on the floor with
my eyes closed for a few minutes (my next and last class of the day told me, “well
if Ms. Cannon suddenly lays on the floor we know why.”)
I love my colleagues and students. However, when you work in
a place where everyone gets concerned about you and something like this happens
in such a public manner you then have a lot of people you have to reassure. I
had to spend much of my afternoon reassuring people. It takes time, but it sure
makes you feel loved.
