Ear tubes 101: Ear tube surgery for kids

Ear tubes, also known as tympanostomy tubes, are tiny devices inserted into the eardrum to help reduce chronic ear infections and fluid buildup in children’s ears. Often recommended for children who experience frequent ear infections or persistent fluid that affects hearing, ear tubes allow ventilation in the middle ear, reducing pressure and helping to prevent future infections. This guide covers everything you need to know about ear tubes — from when they may be necessary to what to expect during and after the procedure — so you can make an informed decision about the best care for your child’s ear health.

In this blog:

• What are ear tubes? 
• Why do kids get ear tubes or “tubes in their ears”? 
• What do ear tubes look like?
• What do ear tubes do?
• What age do children normally have ear tubes put in?
• Ear tube surgery in infants, toddlers and children
• What to expect after ear tube surgery in infants, toddlers and children
• Children’s behavior changes after ear tube surgery
• Alternatives to ear tubes for children

What are ear tubes?

Does your child suffer from multiple ear infections? If repeated courses of medications haven’t worked, a simple procedure is highly effective at helping children who suffer from these repeated ailments: Ear tubes.

Ear tubes are tiny cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum. An ear tube creates a passageway to ventilate the middle ear and prevents fluid buildup behind the eardrum. Ear tubes are commonly associated with children, but they can also be used for adults in certain situations, like chronic ear infections, eustachian tube dysfunction or ongoing fluid buildup that doesn’t resolve on its own.

For children who suffer from frequent ear infections or persistent fluid that impacts hearing and speech development, ear tubes can be a highly effective treatment. By allowing proper ventilation, ear tubes help reduce the recurrence of infections and alleviate the discomfort associated with ear pressure and fluid accumulation.

Why do kids get ear tubes or “tubes in their ears”?

Children receive ear tubes for a variety of reasons. The child’s language, speech and various elements of their intellectual development will impact the decision about who might benefit from ear tube surgery. The basic national guidelines for tube placement include children who have:

• Ear fluid that persists behind the eardrum for 3–6 months
• More than 6 ear infections in 1 year
• Greater than 30 dB conductive hearing loss in either ear
• Speech, language or learning delays

Other special circumstances (including Down syndrome, a cleft palate or another underlying medical condition that would mean the child would benefit more from tubes than other children)

Medical management is always the first line of treatment, but the option for tube placement deserves serious consideration if a child hasn’t improved with medications.

What do ear tubes look like?

Ear tubes are tiny and hollow. Some people say they look like a tiny spool or grommet.

The eardrum is about the size of a dime.

Photos courtesy of the American Academy of Otolaryngology – Head and Neck Surgery Foundation

What do ear tubes do?

Ear tubes improve airflow and prevent fluid buildup in the middle ear. Ear tubes allow any fluid that does accumulate to drain through the tube, reducing the risk of infection and hearing problems.

Ear tubes typically stay in place for about 9 to 18 months, depending on the specific tube used. They typically fall out on their own. If they don’t, your doctor may suggest removing them.

What age do children normally have ear tubes put in?

Children of different ages need tubes for different reasons, but most children who undergo this surgery are between 6 and 12 months old. Having ear tube surgery is rare after 10 years old but can happen in some cases.

Ear tube surgery in infants, toddlers and children

Ear tube insertion is the most common outpatient surgery for children in the U.S., according to the American Academy of Otolaryngology–Head and Neck Surgery. 

Ear tube surgery is very straightforward and takes about 5–10 minutes. Because children must be very still, they’ll typically be given general anesthesia with anesthesia air via a mask. The procedure is performed under a microscope. Using magnification, doctors make a tiny cut in the eardrum, remove the fluid and put in a small tube.

The tubes remain in place for a varying amount of time, depending on how fast the child’s eardrum grows, but typically the tube is in place for about 9 to 18 months.

What to expect after ear tube surgery in infants, toddlers and children

Immediately after ear tube surgery, most kids act like nothing ever happened. They can resume normal activity, such as going to school or daycare, the next day. There are no restrictions with swimming or bathing.

After the ear tubes are placed, we expect the child will have fewer and less severe ear infections and less fluid buildup. These improvements should mean their hearing will be better, their language acquisition may improve and their behavior and concentration skills may be enhanced.

In many children, you can see an almost immediate hearing improvement. It can take up to 6 months to see the impact of the ear tubes in kids and depends on the severity or frequency of ear infections. With ear tubes, ear infections may manifest with ear drainage that can easily be treated with antibiotic ear drops.

Children’s behavior changes after ear tube surgery

Typically, we see:

• Better hearing and speech if chronic fluid was present prior to ear tube insertion
• A small percentage of children don’t like water in their ears with swimming or bathing; ear plugs are an option
• Temporary sensitivity to loud sounds, since hearing may have been affected by chronic middle ear fluid. Children will eventually acclimate to hearing much better after surgery

Alternatives to ear tubes for children

Alternatives to ear tubes include watchful waiting to see if the ears improve with time, antibiotic ear drops and addressing any potential underlying causes of infections or fluid, such as allergies or sinus problems.

However, it’s important to weigh the risks and benefits of watchful waiting. Hearing and speech may be impacted, especially for children who are learning how to talk.

We don’t want hearing and speech to be impacted in a child who is learning how to talk. We also don’t want children to be exposed to too many rounds of antibiotics by mouth, as this could lead to antibiotic resistance.

Our ear, nose and throat experts can help

Our team of specially trained experts in our Ear, Nose and Throat (Otolaryngology) Division diagnose and treat ear, nose and throat conditions in multiple locations across Houston and Austin.