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pediatric-illness

Ear Tubes in Children: What Parents Should Know

Ear tubes help drain middle-ear fluid and are recommended after recurrent infections or lasting fluid affecting hearing. Same-day procedure, quick recovery. Updated 2022 guidelines clarify most children don't need strict water precautions.

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Lena Park, PNP — Pediatric NP

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Why a doctor might recommend ear tubes

The middle ear is a small air-filled space behind the eardrum. When the Eustachian tube — which connects the middle ear to the back of the throat — does not drain well, fluid can accumulate. In young children, the Eustachian tube sits at a flatter angle than in older children and adults, making drainage harder.

An ENT specialist may recommend tubes when a child has had 12:

  • Three or more ear infections in six months, or four or more in a year (with at least one in the preceding six months)
  • Fluid behind both eardrums for three months or longer, especially if it is affecting hearing
  • Speech or language concerns that may be linked to hearing loss from persistent fluid

What the procedure involves

The procedure is called a myringotomy with tympanostomy tube placement. A surgeon makes a tiny opening in the eardrum, suctions out any fluid present, and places a small tube in the opening. The entire procedure typically takes ten to fifteen minutes 3.

Young children receive a brief general anesthetic so they stay still and comfortable. Most children are awake and eating within an hour of waking from anesthesia, and go home the same day.

Recovery and what to watch for at home

Most children return to normal activity the same day or the following morning. Some drainage from the ear canal in the first day or two is normal — it may appear slightly blood-tinged or yellow as old fluid exits 3.

The surgeon will advise on water precautions. Per the updated 2022 AAO-HNS guideline, routine water precautions are not necessary for most children with tubes, though specific activities (such as diving, bath submersion, or lake swimming) may still warrant discussion with the treating surgeon 1. Antibiotic ear drops may be prescribed if drainage continues.

How long tubes stay in and what happens next

Most standard tubes are designed to fall out on their own over six months to about a year as the eardrum gradually pushes them out 3. The small opening in the eardrum typically heals on its own after the tube is gone. Longer-duration tubes are sometimes used for children who need repeated sets.

Follow-up hearing tests help confirm that hearing has normalized after tubes. Some children need more than one set if the underlying drainage problem persists through the preschool years; the need tends to decrease as children grow and their Eustachian tubes mature 1.

Questions worth asking the ENT before the procedure

Before proceeding, it is reasonable to ask: Has a hearing test been done, and what did it show? Which type of tube is being placed and why? What water precautions are recommended for this child? What does normal post-tube drainage look like versus what warrants a call to the office? 1

Understanding the difference between expected post-tube drainage and a sign of a new infection helps parents manage things confidently at home.

Common questions

Will ear tubes cure ear infections completely?

Tubes significantly reduce how often many children get ear infections, but they don't guarantee none will occur. Some children get an occasional infection through the tube, which often causes visible drainage — in most cases this is treated with antibiotic ear drops rather than oral antibiotics.

Does my child need water precautions with ear tubes?

Per updated 2022 guidelines, routine water precautions are not required for most children with tubes in clean pool water or during bathing. However, diving and swimming in lakes or rivers may still warrant discussion with the surgeon. Ask specifically what is recommended for your child.

What if the tube falls out before it was supposed to?

Tubes can fall out earlier than expected. If a child's ear infections or fluid return after a tube comes out, the provider will evaluate whether a second set of tubes makes sense.

Does needing ear tubes mean something is wrong with my child's immune system?

Not in most cases. Recurrent ear infections in young children usually reflect the anatomy and developmental stage of the Eustachian tube, not a deeper immune problem. The ENT or pediatrician can discuss whether any further evaluation is warranted for a specific child.

Talk to a clinician

Lena Park, PNP — Pediatric NP

kids & families. Gale can match you with a licensed clinician for a visit.

Find care →

When to get care right away

  • —High fever with severe ear pain after the procedure
  • —Heavy or foul-smelling drainage from the ear that is not improving
  • —Sudden hearing loss or significant changes in hearing
  • —Signs of anesthesia reaction after the procedure: difficulty breathing, extreme agitation, or prolonged vomiting

If a child has trouble breathing, will not wake up, or has a seizure after anesthesia, call 911 or go to the nearest emergency department immediately.

This article is general health information for parents, not medical advice for any individual child. A child's ENT surgeon and pediatrician are the right source for guidance specific to that child's situation.

References

  1. 1.Rosenfeld RM, Tunkel DE, Schwartz SR, et al. (2022). Executive Summary: Clinical Practice Guideline on Tympanostomy Tubes in Children (Update). Otolaryngology–Head and Neck Surgery. doi:10.1177/01945998211065661 ✓AAO-HNS updated 2022 guideline on indications for tympanostomy tubes: bilateral effusion 3+ months with hearing loss; recurrent AOM (3 in 6 months or 4 in 1 year); topical antibiotic drops only for uncomplicated tube drainage; water precautions not routinely required
  2. 2.Lieberthal AS, Carroll AE, Chonmaitree T, et al. (AAP/AAFP) (2013). The Diagnosis and Management of Acute Otitis Media. Pediatrics. doi:10.1542/peds.2012-3488 ✓AAP/AAFP guideline thresholds for referral to ENT for recurrent acute otitis media (3 or more episodes in 6 months or 4 or more in a year with one episode in the preceding 6 months)
  3. 3.Giannakopoulos P, Chrysovergis A, Nikolopoulos TP (2022). An Overview of the Tympanostomy Tube. PMC / National Library of Medicine. link ✓Overview of tympanostomy tube types, placement procedure, duration of effect, and follow-up management including hearing testing and when a second set may be needed

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.