Recurrent ear infections, medically known as Otitis Media, are common in young children and can affect comfort, hearing, and development. The decision to place ear tubes, also called tympanostomy tubes, is based on specific medical criteria. The goal of this treatment is to ventilate the middle ear space, reduce infection frequency, and prevent complications from chronic fluid buildup. This article explains the underlying problem, the diagnostic process, the surgery, and long-term care.
Understanding Persistent Ear Issues
The underlying cause of persistent ear problems in children is the anatomy and function of the Eustachian tube. This small canal connects the middle ear to the back of the throat, equalizing pressure and draining fluid. In young children, the tube is shorter, narrower, and more horizontal than in adults, making it less efficient at draining fluid and more susceptible to blockage.
When the Eustachian tube becomes blocked, often due to inflammation, negative pressure develops in the middle ear. This causes fluid to accumulate, resulting in Otitis Media with Effusion (OME), a non-infected fluid buildup. Fluid in the middle ear causes muffled hearing, which can contribute to balance issues, sleep disturbances, and speech delays. If this trapped fluid becomes infected, it leads to Acute Otitis Media (AOM), characterized by pain and fever.
Diagnostic Criteria for Tube Placement
Tube placement is guided by medical evidence indicating a child is at risk for developmental issues from persistent fluid or suffering from frequent infections. For recurrent Acute Otitis Media (AOM), tubes are considered necessary if a child has:
- Three distinct ear infections within six months.
- Four infections within a 12-month period.
Assessment requires that middle ear fluid is present in at least one ear at the time of evaluation.
Tubes are also necessary for children with persistent Otitis Media with Effusion (OME) lasting three months or longer. This is true if the chronic fluid is associated with documented hearing loss, defined as greater than 20 decibels in one or both ears. Hearing evaluations use age-appropriate testing, such as audiometry, and fluid presence is confirmed with tympanometry. The procedure may also be considered for children with OME lasting three months or more who exhibit symptoms like balance problems, behavioral issues, or poor school performance that are likely related to the ear fluid.
The Tympanostomy Procedure and Immediate Aftercare
The insertion of an ear tube, formally known as a myringotomy with tympanostomy tube insertion, is a common and quick outpatient surgery. The procedure is performed under general anesthesia. The surgeon makes a small incision, called a myringotomy, in the eardrum and suctions trapped fluid out of the middle ear.
A tiny tube, often made of plastic or silicone, is placed into the incision to hold the opening open. This tube acts as a vent, equalizing air pressure between the middle ear and the outer ear canal, which prevents fluid accumulation. Patients are typically discharged home within hours, though they may feel tired or slightly off-balance due to the anesthetic.
Post-operative pain is generally minimal and managed with over-the-counter pain relievers like acetaminophen or ibuprofen. Drainage (clear, yellow, or bloody) is common for the first one or two days, indicating that trapped fluid is draining. Antibiotic ear drops are often prescribed for several days to prevent infection immediately following the surgery.
Long-Term Management and Tube Exit
Life with ear tubes requires some minor adjustments, but current medical guidelines no longer recommend routine water precautions for all children. Soapy water, such as during bathing, carries a higher potential for entry and may require ear protection like cotton balls coated in petroleum jelly. Most children can swim in clean, chlorinated water without earplugs, but protection may be needed when swimming in lakes or diving underwater.
The most common types of tubes are designed to be temporary, remaining in place for an average of 6 to 18 months. The body’s healing process naturally pushes the tube out of the eardrum, a phenomenon known as extrusion. Once the tube falls out, the small hole in the eardrum usually closes on its own.
Regular follow-up appointments with the ENT doctor are necessary to ensure the tubes are functioning and the eardrum heals correctly after extrusion. In a small percentage of cases, the hole may not close, resulting in a persistent perforation that may require a minor surgical repair. If the underlying Eustachian tube dysfunction persists and recurrent issues return after the first set of tubes falls out, a second set may be necessary.