What Should I Do If I Can See Ear Tubes Coming Out?

Seeing an ear tube poking out of your child’s ear canal can be startling, but in most cases it means the tube is doing exactly what it was designed to do. Standard ear tubes (tympanostomy tubes) are meant to fall out on their own as the eardrum naturally pushes them outward over a period of months. The eardrum usually heals on its own afterward, and the whole process rarely requires emergency action. That said, knowing the difference between a routine extrusion and a situation that needs medical attention can save you unnecessary worry and keep your child’s ears healthy.

Why Tubes Work Themselves Out

Ear tubes sit in a small opening cut into the eardrum during surgery. Over time, the skin of the eardrum slowly migrates outward toward the ear canal, carrying the tube along with it. Debris gradually builds up under the inner flange of the tube, and once enough has accumulated, the tube loosens and falls into the ear canal or out of the ear entirely.¹ This is the normal endpoint of every tube placement. Short-term tubes (the most common type) typically extrude within six to eighteen months, though the timing varies by tube material and individual healing patterns.

A multicenter study found that tube material is the single strongest predictor of how long a tube stays in place. Silicone tubes lasted an average of about 400 days before extruding, while titanium collar-button tubes averaged around 312 days.² Longer-lasting tubes, like T-tubes, are designed to stay in for years and are usually removed by a surgeon rather than left to fall out naturally. If you’re not sure which type your child has, your ENT’s office can tell you.

Practical Steps When You Spot a Tube Coming Out

If you can see a tube sitting in the ear canal or just barely poking out of the eardrum, here is what to do and what to avoid:

Leave it alone. Do not try to pull it out with tweezers, a cotton swab, or your fingers. Even a tube that looks like it’s barely hanging on is best left for the body to finish pushing out, or for a doctor to remove at the next visit.
Keep water out. Until the eardrum has had time to heal, treat the ear as if it still has an open tube. Avoid submerging the head during baths and use earplugs or a cotton ball coated with petroleum jelly during hair washing.
Note the date. Knowing when you first noticed the tube extruding helps your doctor gauge how the healing timeline is progressing at the follow-up visit.
Schedule a visit. This doesn’t need to be same-day unless your child has pain, drainage, or hearing changes. A routine appointment within a few weeks is usually fine to confirm the tube is out and the eardrum is closing.

Most extruded tubes end up falling into the ear canal and either come out on their own or sit harmlessly until a doctor removes them during a regular check. Occasionally, a tube falls out onto a pillow or into the bath and you find a tiny cylinder no bigger than a pencil-tip eraser. That’s completely normal.

When to Call the Doctor Sooner

A routine extrusion doesn’t need urgent care, but a few situations do call for a quicker phone call:

Persistent drainage. A small amount of clear or slightly cloudy fluid right around extrusion isn’t unusual, but thick, foul-smelling, or bloody discharge lasting more than a day or two can signal infection. Ear drainage in children after tube surgery is usually managed with prescription ear drops rather than oral antibiotics, because topical treatment is more effective and avoids the side effects of systemic medication.³
Pain or fever. Ear tubes extrude painlessly in most children. If your child complains of ear pain or develops a fever around the same time, an infection may have set in as the tube loosened.
Sudden hearing drop. If your child seems to hear noticeably worse right after a tube comes out, fluid may be re-accumulating behind the eardrum. A hearing test can clarify this quickly.
Drainage that won’t stop despite treatment. Ear drainage that doesn’t respond to topical drops can sometimes be caused by a retained piece of tube, granulation tissue, or rarer problems that an ENT should evaluate.³

How the Eardrum Heals After Extrusion

Once a tube falls out, the small hole it leaves behind almost always closes on its own. For standard short-term tubes, the perforation rate after extrusion is low. One review found that about 1% of ears treated with standard straight tubes develop a permanent perforation.⁴ The risk climbs with longer-lasting tubes: a study of over 340 ears found persistent perforations in roughly 7% of ears with short-term tubes versus 20% with long-term tubes.⁵ In that same study, children who had received multiple sets of tubes and those who were older at the time of removal were more likely to have a perforation that didn’t close.

Other factors that raise the odds of a lingering hole include a history of ear discharge while the tube was in place and the presence of aural polyps (small growths around the tube site). Having frequent ear drainage during the tube’s life roughly doubled the likelihood of a persistent perforation, while polyps raised it several-fold.⁶ If the eardrum hasn’t sealed after a few months, your ENT may discuss a minor procedure called a myringoplasty or tympanoplasty to patch the hole surgically. In the meantime, water precautions remain important for any ear with an open perforation.

Hearing After the Tubes Come Out

One of the biggest concerns parents have once tubes extrude is whether their child’s hearing will stay where it was or slide backward. A follow-up hearing test is the clearest way to answer that question. Research on children who had bilateral tube placement shows that hearing generally stays improved after the tubes come out, not just during their time in the ear. In one study, the average hearing gap between what the ear could detect by bone conduction and what it actually detected by air conduction dropped from about 20 decibels before surgery to around 7 decibels several weeks after placement, and it held at that improved level.⁷

That said, the tubes treated the symptom (fluid buildup) rather than curing the underlying tendency toward ear infections or effusions. If fluid returns after extrusion, hearing can dip again. This is why most ENTs recommend at least one hearing check after extrusion and continued monitoring if the child has a history of recurrent problems. A qualitative study of parents in Norway found that even when families became less anxious over time after tube surgery, many still wanted a formal “closure” visit confirming that hearing was as good as it could be and the tubes had been rejected.⁸ That instinct is reasonable. Ask for a hearing test at the follow-up appointment rather than just an otoscope look.

Will Your Child Need Tubes Again?

Some children sail through one set of tubes and never look back. Others develop fluid again within weeks or months of extrusion. Data from a large multicenter registry found that the rate of needing a second set of tubes varied dramatically depending on the type of fluid present at the original surgery, ranging from about 4% for thin, watery effusions up to nearly 39% for ears that had purulent (infected) fluid at the time of the first tube placement.² Children whose tubes came out especially quickly were also more likely to have a recurrence. One study of over 250 ears found that a shorter tube retention time was significantly associated with a higher recurrence rate of middle ear effusion.⁹

If your child’s tubes came out sooner than expected and ear problems return, it doesn’t mean the first procedure failed. It usually means the underlying Eustachian tube dysfunction hasn’t fully resolved yet, which is common in younger children whose anatomy is still maturing. Your ENT may recommend a second set, sometimes paired with an adenoidectomy to address an additional contributing factor. In children who need repeat tubes, longer-lasting tube types or different materials are sometimes chosen to extend the ventilation period.

The Rare Problem of Tubes Going Inward

While the standard path for a tube is outward into the ear canal, in uncommon cases a tube can migrate inward, slipping through the eardrum and into the middle ear space. This is the opposite of normal extrusion and worth knowing about, because it can happen silently. A case series identified six children whose tubes had migrated medially, and in five of those patients the eardrum had healed over the tube, trapping it inside. Half of the children had symptoms from the displaced tube, while the others had no symptoms at all and the tube was discovered incidentally.¹⁰ All of the children ultimately underwent a minor surgical procedure to remove the tube from the middle ear.

One proposed explanation for inward migration is that the original incision in the eardrum was too large, which prevented the skin’s normal outward-pushing mechanism from gripping the tube properly.¹¹ Inward migration is rare enough that most families will never encounter it, but it underscores why follow-up visits matter. If the tube seems to have disappeared without being found in the ear canal or on a pillow, let your ENT know. A quick look with an otoscope or a tympanogram can confirm whether the tube is truly gone or hiding behind the eardrum.

Home Monitoring With Smartphone Otoscopes

For families who live far from their ENT or want to check on things between visits, smartphone-attached otoscopes are becoming a practical option. A pilot study evaluated one such device by having parents capture video of their child’s ear and comparing the images to what doctors saw during traditional in-office otoscopy. The agreement between the two methods was good for key findings like whether a tube was extruding, blocked, or fully out, with at least 80% agreement between the smartphone video and the in-person exam.¹² Agreement between different doctors reviewing the same smartphone footage was even higher.

These devices aren’t a replacement for a trained examiner, and image quality depends heavily on how cooperative the child is and how well the parent can angle the scope. But they can be genuinely useful for flagging whether a tube looks like it’s on its way out, which helps you decide whether to move up a scheduled visit or wait. If your ENT’s practice offers a telehealth option that accepts parent-captured images, it’s worth asking about. The technology is still early, but it’s already accurate enough for basic tube-status checks.

Water Precautions During and After Extrusion

The question of water restrictions is one that parents revisit every time the tube situation changes. While the tube is in place and functioning, most ENTs allow surface-level swimming and bathing without earplugs, reserving water protection mainly for diving or prolonged underwater activity. But when a tube is visibly extruding, the situation is a bit different, because the tube may not be sealing the opening as effectively as it was. Water getting through a partially dislodged tube can introduce bacteria directly into the middle ear.

Once the tube is fully out and the eardrum has healed (confirmed by your doctor), water precautions can usually be dropped entirely. The tricky in-between period, from when you first see the tube loosening to when the eardrum is confirmed closed, is when you should be most careful. Use earplugs or a moldable earplug for baths and swimming, and avoid lake or pool water entering the ear canal if possible. Your ENT can confirm eardrum closure at the follow-up visit, at which point your child can return to normal water activities.

What Tympanostomy Tubes Are Made Of and Why It Matters

If you’re on your child’s second or third set of tubes, your ENT may discuss material options. The most common short-term tubes are made of fluoroplastic (a type of Teflon-like material), titanium, or silicone. As noted earlier, silicone tubes tend to stay in place significantly longer than titanium ones. That difference matters because the tube material was found to be the only independent predictor of how long a tube stays in the ear, outweighing factors like the child’s age or the thickness of the fluid being drained.²

For children who need a longer ventilation period but aren’t candidates for a permanent T-tube, a silicone tube might be chosen over a titanium one to buy extra months. On the other hand, titanium tubes extrude more predictably and are less likely to overstay their welcome. There’s no universally “best” material; the choice depends on your child’s history of recurrence, how their eardrums have healed in the past, and how long the surgeon wants the tube to stay functional. It’s a conversation worth having if you’re facing repeat surgery, because a different tube type might change the outcome this time around.

1
Austin Journal of Otolaryngology. Medial Migration of Tympanostomy Tubes: The Why and What to do? Case report and Review of Literature
2
PubMed Central. Factors Affecting the Extrusion Rate and Complications After Ventilation Tube Insertion
3
PubMed. Management of the draining ear in children
4
PubMed. Ear drum perforations in children after ventilation tube treatment
5
PubMed. Factors affecting persistent tympanic membrane perforation after tympanostomy tube removal in children
6
PubMed. Factors related to persisting perforations after ventilation tube insertion
7
PubMed. Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion
8
American Journal of Otolaryngology. Postoperative care for children after ventilation tube surgery: A qualitative study of parents’ experiences over time in Norway
9
PubMed Central. Predictors of tympanostomy tube extrusion time in otitis media with effusion
10
PubMed. Medial migration of tympanostomy tubes: an overlooked complication
11
PubMed Central. Medial migration of the tympanostomy tube: what is the optimal management option?
12
PubMed Central. Prospective Evaluation of a Smartphone Otoscope for Home Tympanostomy Tube Surveillance: A Pilot Study