Ear tubes (tympanostomy tubes or grommets) are small, hollow devices surgically placed into the eardrum. Their primary purpose is to create a direct airway to the middle ear, allowing air to flow in and out to maintain equal pressure and ventilate the space behind the eardrum. This ventilation allows collected fluid to drain out, which helps prevent recurrent ear infections and restore hearing loss caused by chronic fluid buildup. Although effective for middle ear ventilation, their small diameter makes them susceptible to obstruction, a common complication of the procedure.
Why Tube Blockage Occurs
The narrow channel of a tympanostomy tube can become blocked by materials that naturally occur in or near the ear. One of the most frequent culprits is inspissated secretions, which is middle ear fluid or mucus that has dried and thickened, creating a solid plug within the tube’s lumen. Blockage is a known complication that can affect a significant percentage of ears with tubes.
Earwax, or cerumen, is another common material that can obstruct the tube, particularly if it is pushed deep into the ear canal. Immediately following surgery, the tube can also become temporarily blocked by clotted blood or surgical debris. Less common are epithelial casts, which are shed skin cells that combine with other secretions to form a physical obstruction. The presence of an obstruction means the tube has become briefly ineffective, potentially leading to a re-accumulation of fluid in the middle ear.
Recognizing the Signs of a Clog
A functioning ear tube allows air and fluid to move freely, so a primary sign of blockage is the return of the original symptoms the tube was meant to prevent. This often manifests as muffled hearing or a sensation of fullness or pressure in the ear. These symptoms occur because the tube is no longer ventilating the middle ear, allowing fluid to collect and pressure to become unequalized.
If the ear had been experiencing a discharge (otorrhea), the sudden cessation of that drainage can indicate the tube has become clogged and is trapping the infected fluid inside. In some cases, a visible observation of the ear canal can reveal the blockage, appearing as a dark plug of cerumen or a whitish, thick discharge material. When the tube is completely blocked, it can lead to discomfort and may set the stage for a new middle ear infection.
Immediate Home Care and When to Seek Medical Help
Home Care and Prevention
If an obstruction is suspected, the first step is often to attempt to clear the tube using prescribed ototopical drops, which are specifically formulated to be safe for the middle ear. These drops may contain an antibiotic, sometimes combined with a steroid, which helps to dissolve the blockage and treat any underlying infection. To administer the drops effectively, the patient should lie on their side with the affected ear facing upward, and the prescribed number of drops should be placed directly into the ear canal.
After application, remain in this position for five to ten minutes to allow the medication time to penetrate the tube. Massaging the small cartilage bump in front of the ear canal can help move the drops through the tube. Only drops recommended or prescribed by a healthcare provider should be used, as many over-the-counter earwax-softening drops are not safe for use with a tube and can potentially damage the inner ear. Avoid using cotton swabs or any other pointed objects to try and clean the ear canal, as this risks pushing the obstruction deeper. Prevention involves managing earwax buildup and treating upper respiratory infections promptly. Unless specifically directed by a physician, water precautions should be followed.
When to Seek Medical Help
Contacting an otolaryngologist (ENT specialist) or pediatrician becomes necessary if home-based efforts fail to clear the tube or if new signs of infection appear. Seek medical attention if the tube remains visibly blocked or if symptoms like muffled hearing or fullness persist after 24 to 48 hours of using prescribed ear drops. The development of fever, persistent or increasing pain, or foul-smelling discharge from the ear are clear indicators that professional intervention is required.
In the clinic, a healthcare provider can examine the ear using an otoscope or a microscope to confirm the nature and location of the blockage. Professional clearance of the tube is often achieved using a specialized micro-suction tool, which safely removes the obstructing material under direct visualization. This technique is far safer and more effective than home remedies for stubborn clogs like hardened cerumen or thick, dried mucus. Attempting to mechanically clear the tube at home should be avoided entirely.