Doctors drain ears in two main ways, depending on where the fluid is. For fluid trapped behind the eardrum in the middle ear, a surgeon makes a tiny incision in the eardrum and suctions the fluid out, a procedure called myringotomy. For blockages in the outer ear canal, like compacted earwax, doctors use a small vacuum tip to suction material out directly. Both procedures are quick, but they solve very different problems.
How Middle Ear Fluid Gets Drained
When fluid builds up behind the eardrum, it can’t drain on its own because the eardrum seals the middle ear space off from the ear canal. To reach that fluid, an ENT surgeon performs a myringotomy: a small, precise cut through the eardrum itself.
The surgeon starts by positioning an operating microscope to get a magnified view of the eardrum. A funnel-shaped speculum (the cone-shaped tool you’ve seen during ear exams) is placed in the ear canal to hold it open and give the surgeon a clear line of sight. The surgeon examines the eardrum, looking for signs of fluid behind it, and then uses a tiny specialized blade to make an incision in the lower portion of the eardrum. The upper-back area of the eardrum is avoided because the delicate hearing bones sit just behind it.
Once the incision is made, the surgeon uses a very fine suction tube to draw the trapped fluid out through the opening. Antibiotic drops or saline are then placed into the ear to rinse away any blood from the incision site. The surgeon may gently press on the small flap of cartilage at the front of your ear (the tragus) a few times to help pump the drops through. The entire procedure typically takes about 15 minutes.
When Ear Tubes Are Placed
If the fluid keeps coming back after draining, a surgeon will insert a tiny tube through the eardrum incision to keep the opening from healing shut. These tubes, sometimes called grommets, are only a few millimeters across and sit in the eardrum like a tiny rivet. They allow air to flow into the middle ear space continuously, which prevents fluid from re-accumulating and stops the eardrum from getting sucked inward by negative pressure.
There are two basic designs. Short-term tubes are built to stay in the eardrum for about 8 to 15 months before the ear naturally pushes them out. They have a small outer flange, and as the eardrum’s skin grows outward over time, it gradually works the tube loose. Long-term tubes lack that outer flange, so the skin can’t push them out as easily, and they stay in place for roughly 15 to 18 months. Most tubes today are made from silicone or fluoroplastic, though titanium and gold versions also exist. Some are coated with materials that resist bacterial buildup.
In most cases, ear tubes fall out on their own within 9 to 18 months. If a tube hasn’t come out after two years, a surgeon can remove it in a brief procedure.
Who Needs This Procedure
Not every ear infection or bout of fluid calls for surgery. The American Academy of Otolaryngology has specific thresholds. A doctor will typically recommend draining the ear or placing tubes when:
- Fluid persists for more than 3 months without clearing on its own.
- Hearing loss exceeds 30 decibels due to fluid behind the eardrum. That’s roughly the difference between hearing a whisper clearly and not being able to hear it at all.
- Ear infections keep recurring, defined as more than 3 episodes in 6 months or more than 4 in a year.
Children are the most common candidates because their ear anatomy makes them more prone to fluid buildup, but adults get the procedure too.
Anesthesia: Children vs. Adults
For children, ear tube surgery is done under general anesthesia, meaning the child is fully asleep. The procedure itself is fast, often under 15 minutes, but young children can’t hold still for a blade near their eardrum, so sedation is necessary.
Adults typically have it done in the clinic while awake. A numbing agent is applied directly to the eardrum’s surface using a small cotton-tipped applicator. This deadens the area enough that the incision and tube placement cause only mild pressure or brief discomfort rather than sharp pain.
How Well It Works
For children, the results are strong. A retrospective study tracking patients after tube insertion found an 85.1% cure rate at one year for pediatric patients, meaning the eardrum returned to normal, fluid stayed gone, and hearing recovered. Adults didn’t fare as well in the same study, with a 53.2% one-year cure rate, partly because the underlying causes of fluid buildup in adults tend to be more complex. Tubes with ongoing ventilation significantly reduced recurrence compared to simply draining the ear and letting the incision heal closed.
Hearing improvement often begins within a few days of the procedure, though it may take a little longer for the ear to fully adjust.
Recovery and Water Precautions
Mild discomfort in the affected ear is normal for the first day or two. Most people can return to regular activities the same day. The most important aftercare rule involves keeping water out of the ear canal. Because the tube creates a direct pathway into the middle ear, water getting through it can cause infection.
When showering, you should place a cotton ball coated with petroleum jelly in the ear opening, or use a waterproof earplug. Swimming requires a waterproof earplug for as long as the tube is in place. Your surgeon will let you know when these precautions are no longer needed.
Possible Complications
A long-term study examining ears ten years after tube placement found that serious complications were rare. Permanent perforation of the eardrum, where the hole doesn’t heal after the tube comes out, occurred in only 0.6% of ears. Thinning of the eardrum happened in 1.2% of cases. The most common finding was myringosclerosis, small whitish calcium deposits on the eardrum, seen in about 17% of ears. These deposits are usually cosmetic and don’t affect hearing. No cases of cholesteatoma, an abnormal skin growth in the middle ear, were found.
Microsuction for Outer Ear Blockages
If the problem is in the ear canal itself, such as compacted earwax or debris, doctors use a different approach called microsuction. This doesn’t involve cutting the eardrum at all. The doctor first looks into the ear canal with a magnifying otoscope or a tiny camera called an endoscope to locate the blockage. Then they insert a long, thin vacuum nozzle into the canal and gently suction the material out. If the wax is particularly stubborn, small forceps or a curette (a tiny scoop) may be used to loosen it first.
The actual suctioning takes only a few minutes. It can be a bit noisy, since the vacuum creates a buzzing or humming sound close to your eardrum, but it’s generally painless. No anesthesia is needed, and you can go about your day immediately afterward.