Ventilation Tubes for Children Zagreb — Secretory Otitis

Diagnosis

Secretory Otitis — Fluid Behind the Eardrum

Secretory (serous) otitis — also known as "otitis media with effusion" — is a common problem in childhood. In children, due to the anatomical position of the Eustachian tubes or their obstruction by the adenoids, fluid accumulates inside the middle ear, leading to recurrent infections and hearing loss. The fluid trapped behind the eardrum creates problems that can significantly affect a child's development.

With serous otitis, parents often notice that their child hears less well or turns the television up too loudly. Frequently they also receive a comment from nursery staff or teachers who have the impression that the child is hard of hearing. The problem is that the symptoms are not dramatic — and for this reason they are often overlooked. The wisest course is to consult an otology specialist immediately for early diagnosis.

Warning Signs to Watch For

Hearing and Communication

The child hears less well, turns up the TV, asks for sentences to be repeated, does not react to quiet sounds, or does not respond when called by name.

Speech and Development

Delays in speech development, difficulty communicating with peers, problems with socialisation and learning in nursery or school.

Recurrent Infections

Frequent ear infections (otitis media), ear pain, the child complains of pressure or fullness in the ear, especially after bathing.

Behaviour

The child is inattentive, has difficulty following instructions, withdraws in noisy environments — signs that teachers and speech therapists know how to recognise.

Consequences of Untreated Condition

Conductive hearing loss that, if left untreated, can become permanent
Increased risk of bacterial infections and inflammation
Impaired development of speech and communication skills
Problems with socialisation and learning

Endoscopic Approach

Endoscopic Ventilation Tube Insertion at Poliklinika Malić

At Poliklinika Malić we employ the modern technique of endoscopic myringotomy with ventilation tube insertion. Dr. Mislav Malić, an ENT specialist with experience of over a thousand endoscopic procedures, uses advanced 4K technology that ensures precision and safety when working with the most delicate structures of a child's ear. The procedure is straightforward — taking just a few minutes — yet the results are often immediate.

Diagnosis is established by examination under endoscopic and microscopic control, with additional confirmation by tympanometry — a specialised hearing test. For persistent cases lasting several months, ventilation tubes inserted into the eardrum are the right solution — Dr. Malić applies a conservative approach first (nasal irrigation, sometimes corticosteroids, improving ventilation) but does not delay surgical treatment in chronic cases.

Trans-canal Approach

The procedure is performed through the natural canal without external incisions — no visible scarring, no sutures.

Enhanced Visualisation

4K endoscopy enables precise examination and access to the eardrum — accurate positioning of the tube at the optimal location.

Immediate Hearing Improvement

The child wakes from anaesthesia with improved hearing — results are visible immediately, which is invaluable for parents.

Minimal Postoperative Discomfort

No dressings, no bandage changes, minimal recovery — the child goes home the same day and resumes normal routine.

Applicable for All Ages

The procedure is applicable regardless of the child's age — even in the very young, thanks to meticulous endoscopic technique.

Reduction of Infections

Children with ventilation tubes develop middle ear infections significantly less frequently — fewer doctor visits, fewer antibiotics.

Procedure and Recovery

The Procedure and Postoperative Care

A ventilation tube is a small plastic tube inserted into the eardrum through a small incision (myringotomy). This implant serves multiple functions: it allows drainage of fluid from the middle ear, ensures proper airflow into the middle ear, prevents re-accumulation of fluid behind the eardrum, immediately improves hearing, and reduces the frequency of ear infections.

Procedure Step by Step

Endoscopic Examination — Detailed endoscopic examination with tympanometry to confirm the diagnosis and plan the procedure.

General Anaesthesia — Short general anaesthesia, safe and routine for children — the procedure takes only a few minutes.

Myringotomy — Making a small incision in the eardrum using the endoscopic method with 4K visualisation.

Fluid Aspiration — Thorough removal of the fluid from the middle ear that was causing the hearing loss.

Tube Insertion — Precise placement of the ventilation tube. If needed, removal of the adenoids (adenoidectomy) during the same procedure.

Ventilation tubes typically remain in the ear for 6–12 months or longer. During this period, it is necessary to protect the ears from direct water entry using special fitted ear plugs. Dr. Malić monitors the condition and determines the optimal time for tube removal, although they can sometimes fall out spontaneously. After removal or spontaneous expulsion, the eardrum heals on its own in most cases.

A simple procedure of just a few minutes, yet the results are often immediate. Parents who see their child wake up and immediately respond vividly to sounds they hadn't been hearing — that is a moment that makes it all worthwhile. Many of my young patients are children in whom ear infections seem to occur most frequently — and this operation restores their right to normal development.

Dr. Mislav Malić — Specialist in Otorhinolaryngology and Head and Neck Surgery

Frequently Asked Questions

What Parents Ask Most Often

How long does the tube insertion procedure take?

The procedure itself takes just a few minutes. Including induction of anaesthesia and recovery, the entire process takes approximately 20–30 minutes. The child can go home the same day.

How should the ears of a child with tubes be protected?

The ears should be protected from direct water entry using specially fitted ear plugs. Swimming is possible with protection, and showering does not require special precautions.

When are the tubes removed and what happens afterwards?

The tubes usually remain in the ear for 6–12 months and often fall out spontaneously. Dr. Malić monitors the condition regularly and determines the optimal moment. After removal or spontaneous expulsion, the eardrum heals on its own in most cases.

Is the procedure safe for young children?

Ventilation tube insertion is one of the most common surgical procedures performed in childhood. The short general anaesthesia we use is safe and routine, and the endoscopic technique minimises trauma for the child.

Can adenoidectomy (removal of the adenoids) be performed at the same time?

Yes — in the context of secretory otitis and tube insertion, if the adenoids are causing obstruction of the Eustachian tube, adenoidectomy can be performed during the same operation to improve long-term ear ventilation.

Specialist

Dr. Mislav Malić

Specialist in Otorhinolaryngology and Head and Neck Surgery · FEBORL-HNS · Doctor of Sciences

As one of the few ENT specialists in Croatia who focuses on otology and ear surgery, Dr. Malić frequently sees children with more complex problems who have already seen several doctors. Particularly important to him is the early diagnosis of secretory otitis — hearing loss in childhood can have long-term consequences for speech and development that cannot be fully recovered later.

With over a thousand endoscopic procedures and experience dating from 2018, Dr. Malić has perfected the technique of endoscopic myringotomy across all age groups — from newborns to adult patients.

More about Dr. Malić →

Subspecialist Examination

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If your child is showing signs of reduced hearing, frequent ear infections, or speech development difficulties, endoscopic ventilation tube insertion may be the optimal solution for improving hearing and preventing recurrent infections.

Ear examination under microscope and endoscope with visualisation, and Dr. Malić's professional assessment of your condition and treatment options.

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Ventilation Tubes for Children