Tubes
Tubes ventilate the middle ear. This allows air to enter the ear, reducing the risk of bacterial and/or viral build-up. It also allows secretions that might otherwise enter the middle ear via the nose and eustachian tube to flow out instead of accumulating.
Tubing is used to remove any fluid, secretion, mucus or infection accumulated in the middle ear. Hearing is restored immediately!
Dr. Brousseau installs tubes WITHOUT GENERAL ANESTHESIA in children and adults.
To find out when it's a good idea to install tubes, or permanent tubes, watch the video!
For a video that covers all the details, watch here!
New à la carte pricing! 2000 consultation + bilateral tubes on the same day - $250 per face-to-face follow-up.
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In the case of otitis media, acute or serous otitis, tube insertion heals the otitis immediately.
Then, as the tubes allow the ear to ventilate and prevent fluid from accumulating, they help prevent ear infections, the accumulation of fluid behind the eardrum (serous otitis) and problems associated with deafness.
They also prevent complications from ear infections and the after-effects of repeated ear infections.
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Tubes usually stay in place from 6 to 24 months, allowing most children to grow up without needing them again. Most of the time, the tubes fall out on their own and do not require intervention to remove them.
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Once the tubes have been inserted, particularly the long types used in children, they will move with the growth of the eardrum. As the eardrum grows and regenerates in a spiral movement, the tubes will move smoothly over the surface of the eardrum.
They may change angle (look tilted or straight), migrate around the eardrum (rotation), and/or change depth (as if the length had changed). This process is normal and does not mean that the tube is non-functional or has fallen out.
Surgical removal of tubes should be avoided, as this is associated with a very high rate of residual tympanic perforation.
As recommended by ENT and pediatric associations in Canada and the U.S., Dr. Brousseau follows children every 6 months until the tubes fall out to ensure that the eardrum has healed properly and that there are no after-effects from the surgery.
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What determines whether the tube is functional is the position of the phalanx (the base of the tube), which should be behind the eardrum, and the tube opening (the inside of the tube channel), which should be clear.
The position of the tube changes as the skin covering the eardrum migrates. It is therefore normal for the appearance of the tubes to change or to be unusual in some patients.
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There are several types of tube. The choice of tube used depends on the patient's activities, the patient's medical condition, the tympanic examination and the expected lifetime of the tube.
For children, I recommend long tubes, the same as those used in major Canadian and American pediatric hospitals.
This type of tube allows them to swim and put their heads in water without having to put plugs in their ears. These tubes are also said to have less risk of complications such as leaving a bad scar, falling behind the eardrum or leaving a residual perforation.
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Complications associated with tubes are rare. Some patients may develop a small white scar on their eardrum, called tympanosclerosis. In the majority of cases, this does not affect your child's hearing or the risk of future infection.
A small number of children may develop a small retraction at the site where the tube was, which must be monitored to avoid the development of a cholesteatoma.
In the majority of cases, this does not affect hearing either, and rarely requires treatment. These two complications are typically linked either to a large number of ear infections, the type of tube used or severe tubal dysfunction.
If very short tubes are used, such as 'coil' tubes, there is a risk of the tube falling into the middle ear - in which case a procedure is needed to remove the tube. Dr. Brousseau does not use this type of tube for this reason.
It's also possible that the eardrum won't close after the tube falls out, leaving a perforation that may require repair surgery(tympanoplasty). Perforations are more common with coils, T-tubes and metal tubes - Dr. Brousseau only uses long tubes.
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As recommended by ENT and pediatric associations in Canada and the U.S., Dr. Brousseau follows children every 6 months until the tubes fall out to ensure that the eardrum has healed properly and that there are no after-effects from the surgery.
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Permanent tubes are inserted under the skin of the tympanic ring (rather than through the tympanic membrane).
They are indicated for patients who have already had conventional tubes at least 2 times, patients with tympanic atelectasis (collapse), or other rare ear problems.
Permanent tubes last between 3 and 5 years.
To find out more about permanent tubes, watch the video!
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When you fly, pressure changes. If your middle ear is filled with fluid and there's no space to ventilate the cavity, positive or negative pressure will build up inside the middle ear.
This will lead to pain, eardrum perforation or perforation of the inner ear membrane, which can result in permanent deafness or severe vertigo.
Tubes ventilate the ear, allowing any pressure to subside: in the event of otitis, inserting tubes means you can fly safely.
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The children are immobilized using a specialized pediatric table (papoose board) and my nurse stabilizes the head. The procedure takes less than 90 seconds per ear. The child is stable and secure.
Timely, quality care - An impact you can hear!
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After installing tubes for my 2-year-old, he started talking within a week. His behavior changed completely, and he started sleeping through the night. He's not the same child!
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I have nothing but good things to say about this clinic! My son had to have tubes put in his ears for repeated ear infections.
The operation went very well and my son has been doing wonderfully ever since.
Oh, and the private waiting rooms look like children's playrooms! They've thought of everything. I recommend it a thousand times over!
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We used the clinic's services to have tubes fitted to our 18-month-old child. The operation went well, and was more than successful: our child no longer has any otitis.
Procedure
Tube insertion is a procedure that takes less than 5 minutes for both ears. Dr. Brousseau performs the procedure with an experienced nurse, using an appropriate pediatric procedure table, surgical microscope and micro-instruments.
The procedure takes place in 3 stages: incision, aspiration of the liquid and installation of the tube. Pain during the procedure is similar to that of an otitis and short-lived - between 1 and 5 minutes of discomfort. The noise associated with cleaning the canal and secretions in the ear is the most unpleasant.
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Prior to your consultation, a member of our team will have contacted you to explain how our clinic works and to check whether you would like to have tubes inserted on the same day if necessary.
During your visit, you'll be seated in a private room, where thetube program nurse will conduct a comprehensive questionnaire on your child's medical history.
Elements include: history of ear infections and possible complications, respiratory diseases, medical and environmental risk factors for ear infections, perinatal history, family history, general medical history, speech, hearing and developmental disorders.
Afterwards, the nurse will review your child's file with Dr. Brousseau, who will meet with you to explain the process, conduct a medical examination and possibly insert tubes if necessary.
After the procedure, Dr. Brousseau will come and give you the results of the physical examination and the procedure, if performed, with additional recommendations if necessary.
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To save you travel, we offer a same-day consultation and tube insertion service.
If you would like this service, please contact us beforehand at info@eliemd.com so that a member of our specialized team can assess your needs and prepare you accordingly.
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The procedure takes about 5 minutes for both ears.
In preparation for the procedure, your child is immobilized with a pediatric table specially designed for procedures in children. The procedure is carried out with the assistance of a specialized, experienced nurse.
To insert the tube, Dr. Brousseau cleans the ear canal, then applies a topical analgesic as needed.
She then makes a small incision through the eardrum, causing a pinch followed by relief if there is an infection or fluid build-up.
She then uses suction to draw out the fluid and infection lodged behind the eardrum. This part of the procedure is noisy and can be stressful, especially for children with long-standing hearing problems (the child can now hear better!).
Once the ear is drained of fluid, she inserts the tube through the eardrum with microscopic forceps, causing a slight pinch.
Finally, drops are placed in the ears. Because of this incision, the ear may leak or blood may come out of the ear after surgery. This is normal.
It's important to apply the drops as soon as you get home, and then as prescribed, to prevent the blood from drying out and creating a clog that could obstruct the tube.
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After the procedure, you'll need to put drops in both of your child's ears for 7 days, and use a nasal hygiene protocol to prevent nasal secretions from interfering with tube function.
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The pain of an otitis is greater than the pain of the procedure. The discomfort experienced during the procedure is short-lived (1-2 minutes), and in many cases the surgery provides relief.
Fluid-induced hearing loss is immediately resolved, as are balance problems caused by fluid build-up.
It is possible, especially in children, for the return of hearing to give the sensation that noises are too loud, so it is normal that your child may be afraid of sounds after surgery. Once the tubes are in place, otitis or fluid is no longer a danger, and it's safe to fly.
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Complications associated with tubes are rare. Some patients may develop a small white scar on their eardrum, called tympanosclerosis. In the majority of cases, this does not affect your child's hearing or the risk of future infection.
A small number of children may develop a small retraction at the site where the tube was, which must be monitored to avoid the development of a cholesteatoma.
In the majority of cases, this does not affect hearing either, and very rarely requires treatment. These two complications are typically linked either to a large number of ear infections, the type of tube used orsevere tubal dysfunction.
If very short tubes are used, such as 'coil' tubes, there is a risk of the tube falling into the middle ear - in which case a procedure is needed to remove the tube. Dr. Brousseau does not use this type of tube for this reason.
It's also possible that the eardrum won't close after the tube falls out, leaving a perforation that may require repair surgery(tympanoplasty). Perforations are more common with coils, T-tubes and metal tubes - Dr. Brousseau only uses long tubes.
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In order to answer any questions you may have, the tube program nurse will contact you the day after the procedure to review the important elements of care with you and answer any tube-related questions you may have.
As recommended by ENT and pediatric associations in Canada and the U.S., Dr. Brousseau follows children every 6 months until the tubes fall out to ensure that the eardrum has healed properly and that there are no after-effects from the surgery.
Follow-up
Tubes are a foreign body installed through the eardrum or under the eardrum skin. Canadian and American ENT and pediatric associations recommend a 6-month follow-up for all tube patients, until the tubes fall out. Follow-up costs are included for patients operated on by Dr. Brousseau.
Follow-ups check tube position and function, verify eardrum healing if the tube has fallen out, and monitor medical conditions that may be associated with ear infections: hearing impairment, speech impairment, adenoid enlargement, tonsil enlargement, environmental allergies, etc.
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The day after the procedure, thetube program nurse will contact you to check if you have any questions about your child's care.
We therefore recommend that you take the time to read the document we gave you on your departure, as well as the instructions on the departure prescription. Take note of any questions you may have: we'll be happy to help.
Make sure you have your medication on hand: drops, saline nasal spray and medicated nasal spray.
If you have joint custody or would like another family member to take part in the call, let the nurse know so that she can train all the adults at the same time.
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As recommended by the ENT and pediatric associations in Canada and the USA, Dr. Brousseau follows children every 6 months until the tubes fall out, to ensure that the eardrum has healed properly and that there are no after-effects from the surgery.
During these follow-ups, your child's ENT medical condition will be assessed by the nurse dedicated to the tube program.
At each follow-up, the evaluation includes the following elements: speech development, social development and behavior, motor development, sleep problems, snoring, sleep apnea, nasal, adenoid or tonsil problems.
In short, the 6-month follow-ups allow Dr. Brousseau to ensure that your child is progressing well, that you are able to access the help your child needs(speech therapist, audiologist, neuropsychologist), carry out prevention of the development ofadenoid hypertrophy, and prevent and evaluatesleep apnea.
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According to Canadian and American ENT and pediatric associations, regular follow-up every 6 months is recommended after tube insertion.
These follow-ups allow us to evaluate the functioning of the tubes and the healing of the eardrum. But they also enable screening for problems related to speech development, social development and behavior, motor development, sleep problems, snoring, sleep apnea, nasal problems, adenoids or tonsils.
Follow-ups can take place in person or virtually.
If during the assessment your child has needs in any of these areas, our dedicated nurse will refer you to the necessary services.
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More than a third of our patients live 2 hours or more from our offices. Our goal is to save you trips to the emergency room or your family doctor.
To facilitate follow-up and meet parents' needs, we suggest you purchase a digital otoscope (available for around $30-40).
This will allow you to e-mail us photos of your child's ears for your 6-month follow-up (which we can then do over the phone), or if you ever have a concern about your child's ears.
During the telephone evaluation with the tube program nurse, a questionnaire will be used to assess the same elements as during in-person follow-up: speech development, social and behavioral development, motor development, sleep problems, snoring, sleep apnea, nasal, adenoid or tonsil problems.
If your child has needs in any of these areas, the nurse will help you get support as close to home as possible.
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Hearing disorders can have a significant impact on a child's development, or be associated with other developmental disorders or medical problems.
Dr. Brousseau and her team have developed links with a wide range of professionals, including speech therapists, audiologists, neuropsychologists, pediatricians and sleep assessment centers, to help you get the support and care your child needs in a timely manner.
During follow-up visits, thenurse in charge of the tube program will evaluate your child using a questionnaire. If your child has special needs or challenges, don't hesitate to talk to her!
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Even if your child has had tubes installed elsewhere, Dr. Brousseau is available to provide follow-up care for your child.
This first requires a consultation to take a detailed medical history and physical examination.
Thereafter, regular 6-month follow-ups are set up.
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If you have had tubes installed by Dr. Brousseau, the procedure fee includes the usual follow-up fees associated with installed tubes, so there are no additional follow-up fees .
If tubes have been installed outdoors, a follow-up charge will be applied.
You need to hear...
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To understand
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To learn
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To talk to each other
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![Black and white photo of a young boy in a plaid shirt holding a book and smiling, with a blurred library background.]()
To grow
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To play music
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To pronounce it correctly
Questions
Tubes are a foreign body installed through the eardrum or under the skin of the eardrum. Canadian and American ENT and pediatric associations recommend a 6-month follow-up of all tube patients.
Follow-ups check tube position and function, verify eardrum healing if the tube has fallen out, and monitor medical conditions that may be associated with ear infections: hearing impairment, speech impairment, adenoid enlargement, tonsil enlargement, environmental allergies, etc.
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When the tubes are in place and functional, infections usually manifest themselves as a foul-smelling ear discharge similar to nasal secretions.
The best treatment is to start your prescribed medicated ear drops without any other antibiotics as soon as possible after the onset of discharge. Otherwise, the discharge may cause the tube to fall out prematurely or become blocked and unable to function properly.
Regularnasal hygiene, followed by cleaning - or blowing the nose - and nasal medication are also very important to keep the nose as dry as possible. Most ear discharge is due to an accumulation of nasal secretions! (See the prescriptions you were given at the outset).
The patient does not require oral antibiotics unless a fever of over 39 C oral for more than 48 hours is present.
Don't worry: the discharge indicates that the tube is working and the infection is draining away. Most children do not develop pain or fever.
The discharge may be clear, thick, green, white or even contain blood. There is no danger to hearing.
It's important NOT to put water in the ear if it's leaking. Protect it with a plug.
If your child's ear has been running for more than 5 days despite these treatments, don't hesitate to contact us at info@eliemd.com and explain the situation.
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No. The tubes used by Dr. Brousseau allow you to put your head in the water without any problem, whether in the pool, in the bath or in a swimming pool.
However, it's important to protect your ears from water if the ear sinks!
The restrictions are as follows: you must not dive headfirst or bomb. Deep diving with tubes is also contraindicated - snorkeling on the surface is no problem.
It's advisable (for everyone, with or without a tube!) to avoid putting your head in the water in spas, as hot water allows the growth of aggressive bacteria that can cause serious infections.
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Dr. Brousseau recommends kerosene and cotton-based plugs called Orhopax. These are safe and reusable, and offer protection equivalent to molded plugs.
Foam plugs are not recommended because they accumulate moisture and can cause infection and pressure in the canal.
Silicone plugs are not recommended because they can dry out and fragment inside the canal - and pieces frequently get caught in the canal.
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The drops contain an anti-inflammatory and an antibiotic.
They help reduce inflammation inside the ear and treat accumulated bacteria.
They also clean the ear mechanically, preventing the tube from clogging and falling out prematurely.
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When your child has ear infections, he or she has a blocked ear. When Dr. Brousseau installed the tube, she unblocked the ear.
When you now put the drops in, this gives the impression that the ear is blocked again, which is uncomfortable.
What's more, drops in the ear can cause the tube to move and become blocked, putting pressure on the ear.
This discomfort is temporary and normal.
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After surgery, put 4 drops twice a day in each ear for 7 days.
If your child has a runny ear, repeat exactly the same thing until the ear stops running for 2 days, or for a maximum of 10 days. Don't forget to increase the frequency of nasal hygiene to keep the nose dry!
If the ear leaks for more than 10 days, write to us at info@eliemd.com explaining the situation, and we'll be happy to help you.
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The nose is connected to the middle ear by the eustachian tube. High-flow nasal sprays can irritate the opening of the eustachian tube, or even introduce water into the middle ear.
In the absence of a tube, this can cause serous otitis or even acute otitis. In the presence of a tube, this can contribute directly to ear leakage (water escaping from the middle ear through the tube) or premature tube drop.
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When tubes are installed, Dr. Brousseau cleans the ear canals. However, blood may accumulate after surgery, especially in cases where there was an active infection.
Never use cotton swabs in your ears!
Blood and earwax can be removed naturally by applying 4 to 5 drops of olive oil at room temperature at bedtime for around 2 weeks. In most cases, this cleans the ear properly.
Note: If you're already applying medicine drops, you don't have to apply olive oil at the same time!
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Fitting tubes allows you to fly immediately after the procedure: the ear is free of secretions, and the tube allows pressure equalization without endangering the ear.
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During the procedure, you have 5 renewals for drops and one year of nasal hygiene products.
To renew your prescription, simply ask your pharmacist to send us a fax, and we'll be happy to renew it for you.
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