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Ear Tubes

Reviewed by Brunilda Nazario, MD on August 25, 2020

What Are Ear Tubes?

Ear tubes are very small metal or plastic tubes a doctor inserts in your child’s ears to help reduce the number of ear infections by allowings fluid or pus to drain. Other names for them include tympanostomy tubes, ventilation tubes, myringotomy tubes or pressure equalization tubes.

They’re like a section of a really tiny drinking straw. They’re round, hollow, and usually made of metal or plastic.

Your doctor makes a small opening in the eardrum and puts in the tube to let air into the middle ear.

Almost all children have at least one ear infection by the time they’re 5. But if they occur over and over or your child has hearing loss because of fluid build-up, your doctor might suggest ear tubes.

If other treatments aren’t working, they can provide relief for your child. They also prevent long-term hearing problems.
 

Chronic Ear Infections

These happen when viruses or bacteria collect in the middle ear, the space right behind the eardrum. Children get more ear infections than adults because their bodies are still developing.

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In kids, the parts of the ear that drain fluid, the Eustachian tubes, are smaller and almost level to the ground. That means they don’t drain as well even when a young one is healthy.

When the Eustachian tubes swell or fill with mucus, perhaps during a cold, it’s even worse. It creates just the right conditions for bacteria to thrive, which can lead to infection. And for some kids, it just happens more often.

During an infection, fluid builds up in the middle ear. That creates pressure and pain. It also explains the following signs and symptoms:

  • Fluid coming from the ear
  • Hard time sleeping
  • More fussiness or crying than normal, especially when lying down
  • Seeming clumsy or having trouble with balance
  • Tugging at an ear

 

When to Treat Chronic Ear Infections

Your doctor might take a wait-and-see approach. Often, a typical infection goes away on its own, especially if it’s from a virus. Sometimes your child needs antibiotics to kill infections caused by bacteria.

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But some kids just get a lot of ear infections and sometimes they don’t clear up very easily. Usually, it doesn’t cause long-term problems, but frequent ones can lead to:

  • Delays in learning speech and developing social skills
  • Hearing loss
  • Infection that spreads to other parts of the head
  • Tears, or holes, in the eardrum

 

Treating Ear Problems with Ear Tubes

Whether your child needs tubes depends on their  history with infections. Your doctor might suggest tubes if your child gets a lot of them, meaning:

  • Three or more in 6 months
  • Four or more in a year

Most commonly, kids get tubes because of:

  • Trapped fluid behind the eardrum
  • Long-term infections that antibiotics haven’t helped
  • Fluid buildup that causes hearing loss, even if there’s no infection
  • Persistent ear infection that results in tearing or a hole in the eardrum

How Ear Tubes Work

Ears have natural ventilation through your eustachian tubes -- narrow tubes that run from your middle ear to high in the back of your throat. The side of the tube in your throat opens and closes in order to:

  • Stabilize air pressure
  • Refresh the air in your ear
  • Drain fluid

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When swelling or mucus keeps natural ventilation from working, ear tubes act as a small window for your ear. They provide an alternative way to help air flow into and out of the ear, which keeps pressure even and helps the ear drain better.

With better airflow, fluid won’t build up and bacteria won’t have such a friendly home.

If your child has hearing loss from fluid buildup, it goes away as soon as the tubes are in. For delays in development, you’ll likely see improvement in the weeks and months ahead.

Ear Tube Surgery

Before your child’s surgery, you will likely get instructions from the hospital. Children who need to be given something to sleep will have to fast, or go without eating, for a certain number of hours before the surgery. Your child won’t be able to eat anything and can drink only certain liquids.

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Check with your doctor to make sure you know:

  • How long your child has to fast
  • What liquids are OK
  • If your child can take any medicine beforehand

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Your doctor also will want to know about:

  • Any medicine your child takes
  • Problems that your child or anyone in your family has with drugs used for anesthesia (which make you unconscious so you won’t feel pain)
  • Your child’s drug allergies 

For adults getting ear tubes, your doctor may have similar questions.

Children, like some adults, will have concerns about what’s happening. To help them get ready for surgery, you may want to:

  • Ask questions so they can talk about their feelings and you can make sure they're not confused about anything.
  • Be specific about how the surgery will help, such as, “Your ear will feel so much better!”
  • Talk ahead of time about going to the hospital. A good general rule is to talk 2 days ahead of time for a 2-year-old, 3 days for a 3-year-old, and so on.
  • Let them pick a toy or blanket to take to the hospital.
  • Remind them you’ll be there the whole time.

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As you talk with children, it’s best to avoid certain phrases. If you say “put you to sleep,” that may remind them of a pet that’s been put down. Instead, you could talk about how a special doctor has medicine to help them sleep really well. The words “cut” or “make a hole” may make a child think of pain. Instead, you can say “make a small opening.”

On the day of the surgery, the first step for younger children is to get medicine so they’ll sleep through the procedure. The main reason is to make sure your child doesn’t move during the procedure.

You’ll take your youngster to a hospital or outpatient surgery center, and doctors will keep a close eye on their heart rate, oxygen, and blood pressure to make sure everything’s going well.

Older children and adults can have the surgery while they’re awake. For them, it can be done in the doctor’s office.

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Ear tube surgery takes only about 15 minutes. During it, the surgeon:

  • Makes a tiny cut in the eardrum with a scalpel or laser
  • Removes fluids from the middle ear with suction
  • Puts the tube into the hole in the eardrum

After it’s over, your child will go to a recovery room so nurses and doctors can be sure there were no problems. If all is well, you should be able to take your child home within a few hours.

Surgery and anesthesia can make kids groggy and possibly nauseated for the rest of the day. They should be back to normal after 24 hours.

Your doctor will schedule a follow-up appointment 2 to 4 weeks after the surgery to see if the tubes are in the right place and working well.

Risks of Ear Tube Surgery

Ear tube surgery is a safe procedure and doesn’t pose much serious risk. However, your child could have:

  • Bleeding or infection
  • Scars or weakness in the eardrum
  • Tubes that fall out
  • Drainage of ear fluid that doesn’t stop
  • Blockages in the tubes from blood or mucus
  • Eardrums that don’t close after tubes are removed

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Some children have problems after being under anesthesia, and may have:

  • An allergic reaction
  • Trouble breathing
  • Heart irregularities
  • Nausea or vomiting

During recovery, talk to the doctor if your child has:

  • Yellow, brown, or bloody ear discharge for more than a week
  • Pain
  • Hearing problems
  • Balance problems

Ear Tube Surgery Recovery

Children who have been given anesthesia take some time to fully wake up.

They may be groggy, fussy, or a little queasy in the first 24 hours, but after that, they should be back to normal. You can usually take them home a few hours after the surgery.

Your child can go home right away if they weren’t given any anesthesia. The same is true for adults who get tubes.

Your doctor will talk to you about next steps. If everything goes as expected, this might mean a follow-up in 2 to 4 weeks, a hearing test, or ear drops to limit fluid coming from the ears.

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If you see yellow, brown, or bloody fluid from the ear for more than a week after surgery, tell your doctor. You’ll also want to check with them if your loved one has ear pain, hearing problems, or trouble with balance.

Some ear tubes are for the short-term. They go in for 6 to 18 months and usually fall out on their own. Others are designed to stay in for longer. They may fall out on their own or might need to be taken out by a doctor.

Once the tubes are out, the opening in the eardrum usually closes on its own. If it doesn’t, your doctor may do a procedure to fix it.

WebMD Medical Reference

Sources

SOURCES:

American Academy of Otolaryngology -- Head and Neck Surgery: “Ear Tubes.”

Mayo Clinic: “Ear infection (middle ear),” “Ear Tubes.”

NIH, National Institute on Deafness and Other Communication Disorders, “Ear Infections in Children.”

Nationwide Children’s Hospital: “Ear Tubes.”

UnityPoint Health: “Frequently Asked Questions About Ear Tubes.”

National Health Service (U.K.): “Can I eat or drink before an operation?”

St. Joseph’s Children’s Hospital: “Preparing Your Child for Surgery.”

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