Conductive hearing loss associated with pressure equalization tubes

Pressure equalization (PE) tube placement traditionally has been used to lessen conductive hearing loss with chronic middle ear effusion. It is assumed that the small diameter of the tube should not interfere with the conduction of sound. In this article we present 5 patients in whom placement of a PE tube resulted in significantly worse conductive hearing. Occlusion of the PE tube with cigarette paper or Gelfoam improved hearing, as documented with audiometry. The average conductive hearing losses attributable to the ventilation tube for this series of patients were 22, 17, 15, 13, 4, and 10 dB at the frequencies of 250, 500, 1000, 2000, 4000, and 8000 Hz, respectively. This amount of change attributable to PE tubes in this small selection of patients is much greater than would be commonly appreciated. We conclude that the opening in the tympanic membrane provided by PE tubes can potentially result in a significant conductive hearing loss. Discussion includes those conditions in which reduced hearing may be more likely to occur.