Ear infections are a common concern, especially in children. When recurrent infections become a problem, ear tubes, also known as tympanostomy tubes, are a common treatment option. These small devices help manage fluid buildup and reduce the frequency of infections. However, their presence does not entirely eliminate the possibility of future ear infections. This article explores how ear tubes function, why infections can still occur, and how they are managed.
How Ear Tubes Work
Ear tubes are tiny, hollow cylinders, often made of plastic or metal, that surgeons place into the eardrum during a myringotomy. Their function is to ventilate the middle ear, the air-filled space behind the eardrum containing the small bones that transmit sound. Normally, the eustachian tubes connect the middle ear to the back of the throat, helping to equalize air pressure and drain fluid.
When these natural tubes become swollen or blocked, often due to colds, allergies, or other respiratory infections, fluid can accumulate in the middle ear. This creates pressure, pain, and an environment conducive to infection. Ear tubes create an artificial opening in the eardrum, allowing air to flow into the middle ear and enabling fluid to drain out. This ventilation reduces fluid buildup, equalizes pressure, and helps prevent recurrent middle ear infections.
Reasons for Continued Infections
Despite the benefits of ear tubes in preventing middle ear fluid accumulation, infections can still occur. The tube creates a direct pathway, allowing bacteria from the outer ear, nose, or throat to enter the middle ear. This direct access can lead to new infections.
Infections can also be caused by different types of pathogens. While tubes help with bacterial infections by allowing drainage and direct antibiotic application, some infections are viral and not directly addressed by the tube’s drainage function. Additionally, the ear tube itself can become blocked by blood, mucus, or other debris, or it can be displaced. This compromises its ability to drain fluid and ventilate the middle ear, leading to fluid buildup and subsequent infection.
It is important to distinguish between middle ear infections (otitis media), which tubes address, and outer ear infections (otitis externa), often called “swimmer’s ear.” Outer ear infections occur in the ear canal, outside the eardrum, and can be caused by water exposure or irritation. Ear tubes do not prevent these outer ear infections.
Managing Infections with Tubes
When an ear infection occurs despite the presence of ear tubes, symptoms are similar to those without tubes, but with a key difference: ear drainage is more common and often less painful because the fluid can escape. Symptoms include ear pain, sometimes accompanied by a low-grade fever, and noticeable ear drainage that may appear clear, cloudy, bloody, or yellowish, and can have a foul smell. Tugging at the ear, increased fussiness, or trouble sleeping in young children can also indicate an infection.
Consult a healthcare provider, such as an otolaryngologist, if these symptoms appear. The diagnosis typically involves examining the ear with an otoscope to check for signs of infection and confirm the tube’s position. Treatment for ear infections with tubes often involves antibiotic ear drops applied directly into the ear canal. These drops are usually preferred over oral antibiotics for uncomplicated cases, as they deliver the medication directly to the infection site.
To ensure the drops reach the middle ear, gently pumping the tragus (the small flap of cartilage in front of the ear canal) a few times after administration can help. Water precautions, such as using earplugs during bathing or swimming, may be recommended, especially for swimming in lakes or rivers, to reduce the chance of water entering the middle ear through the tube.