Ear tubes (tympanostomy or ventilation tubes) are small, hollow cylinders placed into the eardrum during a brief surgical procedure. Their primary purpose is to equalize air pressure and provide a channel for fluid to drain, preventing chronic buildup that causes hearing loss and recurrent infections. This procedure is common, particularly in young children, offering temporary support while the child’s Eustachian tubes mature. Since they are a temporary solution, the tubes are specifically designed to be extruded, or pushed out, by the body’s natural processes.
The Expected Timeline for Tube Expulsion
The typical duration for an ear tube to remain in place is between six and eighteen months, often falling out around the twelve-month mark. This expulsion is the result of the body’s continuous biological activity. The eardrum (tympanic membrane) constantly renews its outer skin layer, which slowly migrates outwards toward the ear canal walls.
This steady, outward growth, known as epithelial migration, pushes the tube out of the small incision where it was placed. Standard tubes, often called grommets, are classified as short-term tubes. They are smaller and have a simpler design to facilitate this self-expulsion within the eighteen-month timeframe.
Some patients receive long-term tubes, which are larger and feature flanges to anchor them more securely. These tubes are intended to remain functional for two years or more and may not fall out naturally. If a long-term tube remains past its intended window, it often requires scheduled surgical removal by an otolaryngologist.
Signs That the Ear Tube Has Fallen Out
The tube falling out is usually painless and frequently goes unnoticed by the patient or parent. Due to their small size, expelled tubes are often mixed with earwax and naturally migrate out of the ear canal. The tube may be found on a pillowcase, in earwax, or simply lost entirely.
One common sign of expulsion is a sudden episode of ear drainage or discharge (otorrhea). This drainage may contain old fluid, earwax, and sometimes a small amount of blood, which is a temporary occurrence as the ear canal cleanses itself. However, many tubes are expelled without any accompanying fluid. The most definitive confirmation of expulsion is during a routine follow-up examination by a specialist who can visually confirm the tube’s absence and the eardrum’s condition.
When Tubes Stay In Too Long or Come Out Too Soon
Premature Expulsion
Premature expulsion occurs when a tube falls out much sooner than anticipated, often within a few months of placement. This early rejection is a concern because the underlying issue, such as Eustachian tube dysfunction, may not have resolved. This potentially leads to a rapid return of middle ear fluid and recurrent infections. If the original symptoms return, a replacement tube may be necessary to ensure proper middle ear ventilation.
Prolonged Retention
Prolonged tube retention occurs when a standard tube remains embedded in the eardrum for more than two years. Tubes that overstay their welcome increase the risk of complications, including a persistent hole in the eardrum after the tube comes out. Prolonged presence can also lead to scarring called tympanosclerosis or, in rare cases, the formation of a cholesteatoma (a skin cyst behind the eardrum). If a short-term tube remains in place for an extended period, a physician may recommend surgical removal to mitigate these long-term risks.
Post-Expulsion Care and Follow-Up
Once the ear tube has fallen out, the small opening in the eardrum must heal and close completely. The body is typically efficient at this process, and the perforation closes on its own in the vast majority of cases. A follow-up appointment with the ear, nose, and throat specialist is necessary to confirm that the hole has fully closed and the eardrum has healed properly.
This examination often includes a hearing test to ensure normal auditory function has been maintained and that no fluid has reaccumulated in the middle ear. In a small percentage of cases, the hole may not heal spontaneously, resulting in a persistent perforation. If this happens, a minor surgical procedure, such as a tympanoplasty, may be required to close the remaining hole and prevent future middle ear problems.