What to Expect After Getting Tubes in Ears

Most children bounce back from ear tube surgery within hours, often acting like themselves by the same evening. The procedure itself takes only about ten to fifteen minutes under brief general anesthesia, so the recovery is far shorter and easier than what many parents imagine. What follows over the weeks, months, and sometimes years after the tubes are placed, though, involves a mix of welcome changes and a few things worth watching for, from drainage episodes to questions about swimming to the day the tubes eventually fall out on their own.

The First Day and Night

Because the anesthesia used for ear tube placement is very short-acting, children typically wake up within minutes of the procedure ending. Fussiness, disorientation, and even brief crying in the recovery room are normal reactions to coming out of anesthesia, not signs of pain from the surgery itself. Most kids calm down quickly once they see a familiar face and are offered something to drink. Ear discomfort is usually mild enough that over-the-counter pain relief handles it, and many children need nothing at all by the next morning.

Your child can usually eat and drink normally the same day. There is no surgical wound to care for on the outside of the ear, since the entire procedure happens through the ear canal. The surgeon makes a tiny slit in the eardrum, suctions out any trapped fluid, and slides the tube into the opening. Because the cut is so small and the tube holds it open intentionally, there are no stitches to manage.

Ear Drainage in the Early Weeks

A bit of fluid or even blood-tinged drainage from the ear canal in the first day or two is expected and not a reason to worry. The tubes are doing exactly what they were designed to do: letting trapped middle-ear fluid escape. Some children have drainage that lasts a few days; others have almost none.

A more notable form of drainage, called post-tympanostomy tube otorrhea, can show up in roughly one in ten ears in the early postoperative period. One study documented an overall early drainage rate of about 9%, with ears that had thick, mucoid fluid at the time of surgery being far more likely to develop it.

When drainage does appear after the immediate recovery, antibiotic ear drops are the standard first-line treatment. Research consistently shows that topical drops placed directly in the ear work better than oral antibiotics for this situation.¹ That makes intuitive sense: the drops reach the problem site immediately rather than traveling through the bloodstream. Surgeons sometimes apply antibiotic-steroid drops at the time of surgery itself, which has been shown to cut the two-week drainage risk substantially.²

When Drainage Keeps Coming Back

Some children experience repeated or persistent drainage through their tubes, and this is one of the more frustrating aspects of the post-tube experience for families. Chronic drainage is sometimes linked to bacterial biofilms that form on the tube itself. Research has found biofilm colonies on every type of tube examined, regardless of how long the tube had been in place, though tubes removed from children who had ongoing drainage problems carried more biofilm than those from children without drainage issues.³ These biofilms can be resistant to standard antibiotic treatment, which helps explain why some drainage episodes are stubborn.⁴

If your child’s drainage does not clear with standard ear drops, the doctor may try a different antibiotic, take a culture to identify the specific bacteria, or in some cases consider removing the tube if the benefits no longer outweigh the hassle. Chronic discharge is worth being proactive about rather than adopting a wait-and-see approach.

Changes in Hearing

Many parents notice an immediate improvement in their child’s hearing, sometimes even on the day of surgery. This is especially common when a lot of thick fluid was sitting behind the eardrum before the procedure. The tube restores airflow to the middle ear and allows sound to vibrate the eardrum normally again, so a child who had been turning up the TV or saying “what?” constantly may seem noticeably more alert to sounds right away.

For children with cleft palate, who are particularly prone to persistent middle-ear fluid, a prospective study found that those who received tubes showed greater improvements in both hearing measurements and speech clarity compared to those managed without tubes, with speech benefits becoming apparent from about 18 months onward.⁵

For otherwise healthy children, though, the picture is more nuanced. A well-known trial published in the New England Journal of Medicine followed children with persistent middle-ear fluid who were randomly assigned to get tubes promptly or to wait. By age six, the two groups showed no meaningful differences across 30 developmental measures, including IQ, vocabulary, speech-sound production, and auditory processing.⁶ This does not mean the tubes failed; rather, it suggests that for many children, the hearing loss from fluid is temporary and their development catches up regardless. The tubes do provide real-time relief from muffled hearing and reduce active infections, which is valuable on its own even if the long-term developmental trajectory is similar.

Swimming, Bathing, and Water Precautions

This is the question almost every parent asks: do we need to keep water out of the ears? For years, the standard advice was to use earplugs for any water exposure, from baths to swimming pools. The evidence, however, suggests the risk is smaller than most people think.

A randomized controlled trial compared young children who swam and bathed freely without ear plugs to those who used plugs consistently. The plug-free group did have a slightly higher rate of ear drainage, but the difference was small enough that the researchers concluded routine use of earplugs may be unnecessary.⁷ Surface swimming in a treated pool or a normal bath poses very little risk because the tube opening is tiny and surface tension keeps most water from passing through.

The situations where caution makes more sense are deep diving, lake or pond water (which carries more bacteria), and soapy bath water, which has lower surface tension and can more easily seep through. Many ENT doctors now take a relaxed approach for everyday bathing and pool swimming but still recommend plugs for untreated natural water or going more than a couple of feet underwater. Your surgeon’s specific preference is worth following, since they know the type of tube placed and your child’s history.

How Long the Tubes Stay In

Ear tubes are designed to work themselves out over time as the eardrum grows and heals beneath them. The two basic categories are short-term tubes, which typically stay in for six to eighteen months, and long-term tubes, which are designed to remain for years. The choice depends on the child’s age, how severe and recurrent the ear problems have been, and whether there are structural issues with the eardrum such as retraction.⁸

When a short-term tube falls out, you might find it on your child’s pillow or see it during an ear check, or you might never see it at all because it drops into the ear canal and gets carried out with normal earwax. The eardrum usually closes on its own within a few weeks of extrusion. Your doctor will monitor the ear after the tube comes out to confirm the hole has sealed and the fluid has not returned.

If a tube stays in longer than expected, usually past three years, the surgeon may recommend removing it in a brief procedure to let the eardrum heal properly. Tubes that overstay their welcome carry a higher chance of leaving a lasting hole.

What Tubes Can Leave Behind on the Eardrum

The most commonly discussed long-term change is tympanosclerosis, which shows up as a whitish, chalky patch on the eardrum. It is essentially a small scar where the tube sat. One study found that tympanosclerosis appeared in a large portion of tube-treated ears, with rates differing between boys and girls: about 71% of boys’ ears and 31% of girls’ ears developed some degree of scarring after tube placement.⁹ Research has noted that tubes increase eardrum scarring overall compared to no tubes.¹⁰ The good news is that tympanosclerosis almost never affects hearing in a meaningful way. Doctors can see it during an ear exam, and parents sometimes worry when told about it, but in the vast majority of cases it is a cosmetic finding on the eardrum rather than a functional problem.

A more consequential long-term risk is a persistent perforation, meaning the hole in the eardrum does not close after the tube comes out. For standard short-term tubes, this happens in a small minority of ears. One literature review put the rate at about 1% for straight Teflon-style tubes.¹¹ Long-term T-shaped tubes, which grip the eardrum more firmly and stay in longer, carry a higher perforation rate after removal. An audit of 151 ears found a persistent perforation rate of about 12% following T-tube removal or extrusion.¹² Another study that examined 343 eardrums after tube removal found the overall persistent perforation rate was about 13%, with short-term tubes at roughly 7% and long-term tubes at 20%.¹³ Factors associated with a higher chance of the hole not closing included the child’s age at tube removal, the number of tube sets they had received, and the size of the perforation.

If a perforation does persist, it can usually be repaired surgically with a procedure called a myringoplasty, which patches the eardrum using a small graft of the child’s own tissue. This is typically done once the child is old enough and the ear infections have resolved.

When a Second Set Is Needed

Not every child is done after one set of tubes. About one in five children who receive their first set will eventually need a second.¹⁴ Children who are very young at the time of their first tubes, particularly those 18 months or younger, are nearly twice as likely to need another set compared to older children.¹⁴ This makes sense because younger children have more immature eustachian tubes that take longer to grow into proper function.

If your child’s ear problems return after the first tubes fall out, the decision to place a second set often involves a conversation about adenoidectomy. The adenoids sit right near the eustachian tube opening and, when enlarged, can block drainage and harbor bacteria. Several studies show that removing the adenoids at the same time as placing tubes significantly reduces the odds of needing yet another set. One large population-based study found that adenoidectomy reduced the rate of tube re-insertion by about 40% compared to tubes alone.¹⁵ A 2024 analysis from JAMA Otolaryngology found that for children four and older, combining adenoidectomy with tubes was associated with lower odds of repeat tube insertions and reduced need for subsequent oral antibiotics.¹⁶

Adenoidectomy is not typically done with the very first set of tubes in a child who has no other indications for it, but it becomes a stronger consideration if a second or third set is needed, especially in children over four. The added recovery time is modest since adenoid removal is also done under the same anesthetic and adds only mild throat soreness for a few days.

Blocked Tubes

Occasionally a tube gets clogged with dried blood, crusted mucus, or earwax. When this happens, the tube cannot ventilate the middle ear and symptoms may return. A trial that tested eardrops for clearing blocked tubes found that both sodium bicarbonate drops and hydrogen peroxide drops were significantly better than just watching and waiting, though neither solution proved superior to the other.¹⁷ If drops do not work, the surgeon can often clear the tube in the office with a small suction or instrument, which avoids the need for another trip to the operating room.

Quality of Life for the Whole Family

One aspect of ear tubes that does not show up in audiograms or complication rates is the relief families feel. Recurrent ear infections mean repeated courses of antibiotics, sleepless nights, missed daycare and work, and a child who is frequently uncomfortable and unable to hear well. A survey-based study found that tube placement improved quality of life for both children and their parents or caregivers.¹⁸ Parents consistently report fewer ear infections, less antibiotic use, and better sleep in the months following the procedure.

That said, a cost-effectiveness analysis looking at recurrent acute ear infections found that tubes cost roughly $989 more per child than continued medical management and produced only a very small gain in quality-adjusted days, about two-thirds of a day over the study horizon.¹⁹ Medical management was favored in the majority of model scenarios at standard cost-effectiveness thresholds. This does not mean tubes are the wrong choice, because quality-of-life measures cannot fully capture how miserable repeated infections are for a toddler or how much parental work disruption matters. But it does highlight that the decision is not purely medical. For families at the end of their rope with recurring infections, the immediate practical relief of tubes can outweigh marginal cost-effectiveness numbers.

Ear Tubes in Adults

Although ear tubes are overwhelmingly a pediatric procedure, adults occasionally need them too. The most common reasons are chronic eustachian tube dysfunction that does not respond to other treatments, persistent fluid behind the eardrum, or the need to equalize middle-ear pressure in someone with barotrauma or certain conditions affecting the skull base. Adults have the procedure done under local anesthesia in the office rather than under general anesthesia in an operating room, which makes the logistics much simpler. The recovery expectations are largely the same: brief discomfort, possible drainage, and improved hearing if fluid was present. Adults generally tolerate the tubes with fewer complications than children, in part because their eustachian tubes are longer and angled more steeply, which helps drainage. The tubes also tend to stay in place a bit longer in adult eardrums.

One difference for adults is that the underlying problem is less likely to resolve on its own over time. Children usually outgrow eustachian tube dysfunction as their anatomy matures. Adults who need tubes often have a structural or chronic issue, so follow-up tends to be longer-term, and some adults end up with semi-permanent tubes designed to stay in for years.

Rare Complications Worth Knowing About

Serious complications from ear tube surgery are genuinely rare, but they exist. A case report described persistent hearing loss in one ear after tube placement that turned out to be caused by a high-riding jugular bulb, an anatomical variant where a large blood vessel sits unusually close to the middle ear structures. The variant was identified on imaging and explained why the hearing loss did not resolve as expected.²⁰ This kind of situation is extremely uncommon, but it illustrates why any unexpected hearing change after tube placement should prompt a follow-up visit rather than being dismissed.

Other rare possibilities include the tube migrating inward into the middle ear space instead of falling outward, formation of a cholesteatoma (a skin growth behind the eardrum), or damage to the tiny bones of hearing. These are reported in the medical literature but occur in a very small fraction of the millions of tube procedures performed each year. For most children, the procedure ranks among the safest and most straightforward surgeries in all of pediatric medicine.