My 11-year-old son had ear tubes put in at six months of age. These helped the problem with chronic ear infections, but there was a hole left in one eardrum that never closed. A paper-patch surgery was done, but this did not close the perforation. More extensive surgery did not work, either. His hearing tests are okay, but I am worried about long-term effects. Should I take him to another ENT? Is there something else that could be done? The last operation was painful, and he is not looking forward to another.

Lori

Ventilation tubes are extremely helpful for infants and children who suffer from ear pain and hearing loss due to recurrent ear infections or persistent middle-ear fluid. The tubes are placed so that they span the eardrum, thus allowing air to enter the middle-ear space. Eardrums shed their skin very slowly, and in doing so, they eventually "spit the tubes out." This typically occurs six to 18 months after the tubes were placed. One of the unfortunate risks of ventilation tubes is that a nonhealing perforation may be present once a tube falls out of the eardrum. This happens rarely, but it is very bothersome when it occurs.

These perforations are typically very small and do not impair hearing. In your son's case, the hole is probably an annoyance because he needs to keep water out of the "problem ear." If he does get water in this ear, he could get an ear infection. If this happens often enough, it could affect his hearing and may even cause permanent hearing loss. Nevertheless, if he carefully avoids getting water in his ear, he will most likely never have problems due to the perforation.

The perforation does not necessarily prevent him from swimming. His ENT can explain what sorts of earplugs and swim caps must be used in order to keep the ear dry. Still, kids are kids, and he may object to doing anything that sets him apart from the other kids. In my office, I sell (at cost) a variety of brightly colored "ear bands." I have seen many children your son's age who take one look at this headgear and shriek, "BUT, MOM!"

This point deserves emphasis: Provided he is careful, he can live his entire life with a perforated eardrum. The perforation does not HAVE to be closed.

In some cases, perforations are associated with recurrent infections. Such patients are bothered by recurrent ear pain and drainage. For these patients, closing the perforation is a good idea because it will rid them of an annoying problem.

Does your son need to see another ear, nose and throat specialist (ENT)? I suspect that you are asking this question because, after two failed procedures, you are beginning to doubt your ENT's abilities. You need to know, however, that the paper-patch procedure often fails. We do it because it is a simple, painless office procedure. If it works, the doctor has saved the patient from having to undergo a bigger procedure. I would argue that your son has really only had one procedure (the operation) that failed. This procedure has a failure rate of 5-15 percent, regardless of the skill of the surgeon. No technique is perfect, and all operations have a risk of failure. Thus, the failure of your son's second procedure may very well have been a simple case of bad luck.

In deciding whether to have another procedure, you need to ask your son how much the perforation is bothering him. In deciding whether to see a different ENT, you need to ask yourself how you feel about your son's present ENT. If he or she is a kind, caring doctor who explains things well and has a good reputation in the community, I would suggest that you stick with your current doctor.