Ear infections are common, especially in young children. When infections become frequent or persistent, they can cause complications. Acute otitis media (AOM) is a painful ear infection, while otitis media with effusion (OME), often called “glue ear,” involves fluid buildup behind the eardrum without active infection. If a child experiences chronic issues from either condition, the surgical insertion of tympanostomy tubes, or ear tubes, may be considered to restore middle ear function.
When Are Ear Tubes Recommended?
The decision to place ear tubes follows specific medical guidelines based on the frequency of acute infections or the duration of fluid buildup. Tubes are considered a treatment option for two main scenarios: recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME). The primary goal is to prevent complications such as hearing loss, speech delay, or eardrum damage caused by sustained negative pressure.
For recurrent AOM, the standard criterion is three separate infections within six months, or four infections over a 12-month period, with one occurring in the last six months. Tube placement also requires that middle ear fluid be present in one or both ears when the child is assessed for surgery. The presence of fluid confirms ongoing eustachian tube dysfunction, which is the underlying cause of repeated infections.
For OME, guidelines focus on fluid persistence without signs of acute infection. Tubes are recommended if fluid remains in both ears for three months or longer and is associated with documented hearing difficulties. A hearing test is obtained before surgery to confirm the extent of hearing loss, which is often conductive due to the fluid dampening sound transmission. Tubes may also be considered for chronic OME lasting three months or more if the child experiences symptoms like balance problems or behavioral issues, even without documented hearing loss.
What the Tympanostomy Procedure Involves
The insertion of ear tubes, known as a myringotomy with tube insertion, is a common and brief surgical procedure. It is performed under general anesthesia to ensure the patient remains still during the delicate operation. The entire process is usually completed quickly, often in 10 to 15 minutes, and is done on an outpatient basis.
During the procedure, the surgeon makes a small incision in the eardrum, called a myringotomy. Any fluid trapped in the middle ear is then drained or suctioned out. A tiny tube, often shaped like a spool, is inserted into the opening.
The tube ventilates the middle ear and allows fluid to drain out, preventing buildup and equalizing pressure. Immediate post-operative care is minimal, with most patients recovering quickly and returning home the same day. Mild pain is possible but is usually managed effectively with over-the-counter pain relievers.
Weighing the Options: Alternatives and Expected Results
For many cases of OME, especially those without severe hearing loss, the primary alternative to surgery is “watchful waiting.” This approach involves monitoring the fluid and the child’s hearing over a three-month period to see if the condition resolves spontaneously. Since OME often clears up on its own, doctors prefer to avoid surgery unless the fluid persists or developmental concerns arise.
If the fluid remains or infection frequency is high, tube placement offers several positive results. The most immediate benefit is improved hearing, as the tube drains the fluid blocking sound transmission. This improvement is observed almost immediately and is important for young children to prevent delays in speech and language development.
The tubes also significantly reduce the recurrence of acute ear infections by ventilating the middle ear and preventing fluid accumulation where bacteria thrive. The tubes are temporary and are naturally extruded, or pushed out, by the eardrum as it heals, typically falling out within six to eighteen months. After the tube falls out, the small hole in the eardrum usually closes on its own.