Ear Tubes 101

Dr. Ronald Vilela, Board-Certified Otolaryngologist, Associate Director of Perioperative Services at Texas Children’s Hospital and Associate Professor at Baylor College of Medicine, discusses ear tubes. 

Does your child suffer from multiple ear infections? If repeated courses of medications haven’t worked, there is a simple operation that is highly effective at helping children with these repeated ailments.

Ear tubes 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 parents 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.

What are ear tubes?

Ear tubes are tiny cylinders, usually made of plastic or metal, surgically inserted into the eardrum. They create a passageway to ventilate the middle ear and prevent fluid from building up behind the eardrum. Ear tubes are commonly associated with children, but they can also be used for adults in certain situations.

Ear tubes are tiny, hollow cylinders surgically inserted into a child’s eardrum to improve airflow and prevent fluid buildup in the middle ear. 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.

In children, ear tubes are often recommended to address frequent ear infections or persistent fluid that can interfere with hearing and speech development. However, adults may also need ear tubes if they experience chronic ear infections, Eustachian tube dysfunction or ongoing fluid buildup that doesn’t resolve on its own. The procedure for adults is similar to the procedure for children, with the goal of improving ventilation in the middle ear and reducing infection risk. Although less common in adults, ear tubes can provide significant relief for those with chronic ear issues.

Why do kids get ear tubes? 

There are a wide variety of reasons that children receive ear tubes. A child’s language, speech and various elements of their intellectual development will impact the decision of who will benefit from 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 infections in one year
• Greater than 30 db conductive hearing loss in either ear
• Speech, language or learning delay
• 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 patient has not improved with medications.

Why do kids need tubes in their ears?

In children, ear tubes are often recommended to address frequent ear infections or persistent fluid that can interfere with hearing and speech development. 

What do ear tubes do?

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

What do ear tubes look like?

Ear tubes are tiny cylinders, usually made of plastic or metal, surgically inserted into the eardrum. 

What age do children normally have eat tubes put in? 

Children of different ages need tubes for different reasons, but the majority of children who undergo this surgery are between 6 and 15 months of age, and it is rare after the age of 8-10 years.

Ear tube surgery

Ear tubes are surgically inserted into the eardrum. The surgery is minimally invasive and very safe. 

Ear tube surgery in children, toddlers and infants

The procedure is similar for children of all ages, with the goal of improving ventilation in the middle ear and reducing infection risk. Although less common in adults, ear tubes can provide significant relief for those with chronic ear issues.

What does ear tube surgery entail? 

Ear tube surgery is straightforward and takes approximately 5-10 minutes. Because children have to be very still, they will undergo 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 it 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, they are in place for about 9-24 months. During that time period, we expect the child to have fewer and less severe ear infections and less fluid build-up. These improvements should help kids, meaning their hearing will be better, their language acquisition may improve and their behavior and concentration skills may be enhanced.

In many children, there will be an almost immediate hearing improvement. However, depending on the severity or frequency of ear infections, it can take up to 6 months to see the impact of the ear tubes in kids. With ear tubes, an ear infection will manifest with ear drainage that can easily be treated with antibiotic ear drops instead of antibiotics by mouth.

How many ear infections before getting ear tubes?

Although there is no absolute number, your PCP should refer you to an ENT for an evaluation of the ears if your child has three ear infections in four months or four ear infections in six months. Infections typically manifest with fever and a significant change in demeanor, like fussiness, poor sleep and poor feeding. Ear pulling doesn’t necessarily mean there’s an infection, and sometimes ear fluid without infection can be bothersome and result in ear pulling.

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

Most children act like nothing ever happened. They can resume normal activity the next day such as going to school or daycare. There are no precautions with swimming or bathing.

Children's behavior changes after ear tubes

• 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.

Other options for kids, instead of ear tubes

Watchful waiting to see if the ears improve with time. However, it is hard to predict when a child’s ears will mature to a point when ear tubes are not necessary. Thus, there is a need to weigh the risks and benefits of watchful waiting. We don’t want hearing and speech to be impacted in a child who is learning how to talk — and we don’t want children to be exposed to too many rounds of antibiotics by mouth, as this could lead to antibiotic resistance.

Common FAQ about ear tubes

Do tubes in kids' ears hurt? 

Not typically.

Can kids swim with ear tubes? 

Yes: there are no precautions with swimming as long as there is no ear drainage.

Do ear tubes fall out? 

Yes: ear tubes typically fall out on their own 9-24 months from when they were placed.

How to clean ear drainage from tubes? 

There is no need to clean the ears; cotton swabs are not allowed. However, ear drainage with ear tubes should be treated with ear drops for 7-10 days.

What are the symptoms of ear tubes falling out? 

Most of the time, there are no symptoms: thus, children should follow up with their ENT every year after the first post-operative visit to understand whether the tubes are still in.

Do kids get less sick after ear tubes? 

Yes, ear tubes relieve chronic ear fluid, so children get fewer ear infections when they are placed.

To learn more about otolaryngology at Texas Children’s, please visit the otolaryngology website.

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