Ear tubes (tympanostomy tubes or grommets) are small, hollow cylinders placed through the eardrum to ventilate the middle ear space. Their primary purpose is to prevent fluid accumulation and reduce the frequency of middle ear infections. Since the tube creates a temporary opening, it directly connects the ear canal to the middle ear. Ear drops are frequently prescribed and often necessary for care with tubes. However, only drops specifically approved by a physician should be administered, as the tube bypasses the eardrum’s natural protective barrier.
Why Ear Drops Are Prescribed With Tubes
The placement of a tube provides a direct route to the middle ear, fundamentally changing how infections are treated. When a middle ear infection (otitis media) occurs, fluid and pus can drain out through the tube into the ear canal, a condition called otorrhea. The tube acts as a drainage channel, meaning the infection often causes less pain and pressure than it would with an intact eardrum.
This drainage signals the need for topical medication. Ear drops deliver high concentrations of antibiotics and sometimes steroids directly to the site of infection. This localized delivery is highly effective for clearing up persistent drainage or acute infections. Using drops directly through the tube is often preferred over oral antibiotics for uncomplicated infections because it minimizes systemic exposure and focuses treatment where it is needed most.
Critical Safety: Types of Drops to Avoid
The most significant safety consideration when using ear drops with tubes is the risk of ototoxicity—damage to the delicate sensory structures of the inner ear. The inner ear, which contains the organs for hearing and balance, is exposed to the middle ear space through a thin membrane. Since the tube removes the eardrum’s natural protective barrier, standard ear drops formulated for an intact eardrum often contain harmful ingredients.
Ototoxic Ingredients to Avoid
A class of antibiotics called aminoglycosides, such as Neomycin and Gentamicin, should generally be avoided if the tube is open. These compounds, along with certain preservatives, carry a risk of causing permanent hearing loss or balance issues if they reach the inner ear space. The potential for ototoxicity is a serious concern, which is why a prescription is mandatory.
Safe Formulations
Physicians must select non-ototoxic drops, typically formulations containing fluoroquinolone antibiotics (e.g., Ciprofloxacin or Ofloxacin). Fluoroquinolones are the only class of antibiotic ear drops approved for use with an open tube because they are safe for inner ear structures. These drops are often combined with a steroid like Dexamethasone, which helps reduce inflammation and swelling associated with the infection.
Step-by-Step Application Instructions
Proper application technique ensures the medication effectively reaches the middle ear. Before starting, gently warm the bottle by holding it in your hand; cold drops can cause temporary dizziness. The patient should lie down with the affected ear facing upward to allow gravity to assist the medication flow.
To ensure the drops travel through the tube, follow these steps:
- Straighten the ear canal: For a child, gently pull the earlobe downward and backward; for an adult, pull the ear upward and backward.
- Administer the exact number of drops prescribed by the physician, aiming the dropper tip near the entrance of the ear canal without touching the ear.
- Gently pump the tragus (the small flap of cartilage at the front of the ear opening) four or five times to help push the medication through the tube.
- Remain lying down with the ear facing up for one to two minutes to allow the medication sufficient time to penetrate the tube and bathe the middle ear space.