Ear tubes are placed through a short surgical procedure where a doctor makes a tiny cut in the eardrum and inserts a small hollow tube to keep it open. The whole process takes about 10 to 15 minutes per ear and is one of the most common childhood surgeries performed today. Here’s what actually happens before, during, and after.
Why Ear Tubes Are Recommended
Doctors typically recommend ear tubes when a child has recurring ear infections or fluid trapped behind the eardrum that won’t clear on its own. The standard threshold is three or more ear infections within six months, or four or more within a year, with at least one of those episodes happening recently. Tubes are also recommended when fluid has been sitting behind the eardrum for longer than three months and is affecting hearing or development.
That trapped fluid matters because it dulls hearing, often by 10 to 20 decibels or more. For a young child learning to talk, even mild hearing loss during key developmental windows can slow speech and language. The tubes work by ventilating the middle ear space and giving fluid a path to drain, which restores hearing quickly and dramatically cuts down on infections.
What Happens During the Procedure
For children, ear tube placement is done under general anesthesia, which means your child will be fully asleep. There are no IV lines or breathing tubes in most cases. Instead, the anesthesia is delivered through a mask, and children typically fall asleep within seconds. Adults can sometimes have the procedure done with just local anesthesia (numbing drops in the ear canal), depending on the situation.
Once the patient is positioned, the surgeon tilts the head slightly away from the ear being worked on and brings an operating microscope into place. This microscope gives the surgeon a magnified, well-lit view of the ear canal and eardrum. A small funnel-shaped instrument called a speculum is placed into the ear canal, and any earwax blocking the view is carefully removed so the entire eardrum is visible.
The surgeon then uses a specialized tiny blade to make a precise cut in the eardrum, typically in the lower portion. This incision is only about 3 to 5 millimeters long. Any fluid trapped behind the eardrum is suctioned out through this opening. Then, using a fine pick-like instrument, the surgeon slides a small tube into the incision. The tube sits snugly in the eardrum with a small flange on each side holding it in place, like a tiny spool or bobbin. If both ears need tubes, the process is repeated on the other side.
The entire procedure, from start to finish, is remarkably fast. Most surgeons complete both ears in under 15 minutes. There are no stitches. The tube itself holds the incision open, and the eardrum tissue naturally grips the tube to keep it secure.
Types of Ear Tubes
Ear tubes come in two basic categories: short-term and long-term. Short-term tubes are the most commonly placed, especially in children. They’re designed to stay in the eardrum for roughly 8 to 18 months before the eardrum naturally pushes them out on its own. Long-term tubes are built to stay in place for 15 months to several years, and they’re typically reserved for children who need extended ventilation or who have had tubes fall out too quickly in the past.
The tubes are made from various materials. Fluoroplastic (a type of Teflon) is one of the most common, along with silicone, which is softer and easier to remove in the office if needed. Some tubes are made from metals like titanium, stainless steel, or even gold, chosen for how well the body tolerates them. The choice of tube depends on how long ventilation is needed and the surgeon’s preference based on the specific situation.
Recovery and What to Expect Afterward
Children go home the same day, usually within an hour or so of the procedure. Because of the general anesthesia, your child may be groggy, a little off-balance, or mildly nauseous for the rest of the day. In the recovery room, they’ll typically be offered clear fluids or a popsicle to settle their stomach. Once home, there are no dietary restrictions, and the only real guideline is to let them rest under adult supervision for the remainder of that day. After that, there are no activity limits.
Most parents notice a difference in their child’s hearing almost immediately. Studies show that functioning ear tubes improve hearing by 10 decibels or more on average, with some tube types producing improvements above 20 decibels. For many children, that’s the difference between muffled, underwater-sounding hearing and completely normal hearing.
Eardrops are often prescribed for the first few days after placement to prevent infection and keep the tube clear. You may notice a small amount of drainage from the ear in the days following surgery, which is normal and usually just the trapped fluid finally making its way out.
Swimming and Water Exposure
This is one of the most common concerns parents have, and the answer has shifted over the years. Current guidelines from the American Academy of Otolaryngology say that routine water precautions, like earplugs, headbands, or avoiding swimming, are not necessary for most children with ear tubes. The recommended approach is to allow unrestricted water activity first and only introduce precautions if problems develop.
There are exceptions. Children who have recurring ear drainage (especially from certain bacterial infections), those with immune system issues, or those who experience ear discomfort while swimming may benefit from earplugs. Deep diving and exposure to heavily contaminated water, like lake or pond water, are also situations where extra caution makes sense. But for everyday bathing and swimming in treated pools, most kids do just fine without any special protection.
Possible Complications
Ear tube placement is considered routine, but complications occur in about 17% of cases. Most of these are minor. The most common issue is drainage from the ear (called otorrhea), which can happen when a child gets a cold or upper respiratory infection. This is usually treated with antibiotic eardrops and resolves quickly.
Some tubes fall out earlier than expected, and in a smaller number of cases, a tube can migrate inward through the eardrum into the middle ear space. This happens in roughly 0 to 1% of placements and occasionally requires a follow-up procedure to retrieve it. After a tube falls out naturally, the eardrum closes on its own in the vast majority of cases. A small percentage of children end up with a persistent hole in the eardrum that may need a minor repair procedure later.
Scarring of the eardrum is common after tubes but rarely affects hearing in a meaningful way. Some children need a second set of tubes if infections or fluid buildup return after the first set falls out, which happens in roughly 20 to 30% of cases.