Ear tubes, formally known as tympanostomy tubes or pressure equalization (PE) tubes, are tiny hollow cylinders placed in the eardrum to restore ventilation to the middle ear space. This procedure is one of the most common surgeries performed on children in the United States to manage persistent or recurrent ear issues. The tubes mimic the function of a healthy Eustachian tube, which naturally equalizes pressure between the middle ear and the back of the throat. When the Eustachian tube is blocked, air pressure cannot be balanced, and fluid accumulates, leading to recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME). The tube creates a small, temporary tunnel through the eardrum, allowing air to flow in and fluid to drain out, reducing infection and improving hearing.
Medical Criteria for Tube Placement
The decision to place ear tubes is based on specific clinical guidelines established by ear, nose, and throat (ENT) specialists, focusing on the frequency and persistence of middle ear problems. One primary indication is recurrent acute otitis media (AOM), defined as frequent, painful infections. This is typically three or more distinct infections within a six-month period, or at least four infections within a year, with one occurring in the last six months.
Another common reason is chronic otitis media with effusion (OME), often called “glue ear,” where thick fluid builds up behind the eardrum without an active infection. Tubes are considered when this fluid persists for three months or longer, especially if unresponsive to initial observation or medication. Chronic fluid buildup causes significant hearing loss, which can lead to developmental delays in speech and language, balance issues, or poor school performance.
Tubes are also recommended when OME or recurrent AOM causes associated complications affecting a child’s development or quality of life. These complications include noticeable balance problems, behavioral changes, or significant ear discomfort. Tube placement resolves the underlying pressure and fluid issues, reversing hearing loss and alleviating these secondary symptoms.
Understanding the Procedure and Placement
The placement of ear tubes is a quick, outpatient procedure called a myringotomy, typically performed under general anesthesia, especially in children. The process generally takes less than 30 minutes for both ears and does not require an overnight hospital stay. Anesthesia ensures the patient is asleep and comfortable, which is important for young children who must remain still.
The surgeon first visualizes the eardrum using a microscope and makes a tiny incision, usually about two millimeters long, in the lower front section of the eardrum. This incision provides access to the middle ear space. Any fluid present is then gently removed using a small suction tool.
After the fluid is cleared, the small tympanostomy tube is inserted into the incision, where its shape helps it remain securely in place. The tube maintains an open channel between the outer ear canal and the middle ear, directly ventilating the space. This ventilation halts the cycle of fluid accumulation that leads to infection and hearing difficulty.
Life with Ear Tubes and Recovery
Recovery from ear tube placement is generally fast, with most patients returning to normal activity the day after the procedure. Mild pain or discomfort is common immediately after surgery but is usually managed effectively with over-the-counter pain relievers. It is also normal to see some fluid drainage from the ear for a few days, which may be clear, pink, or slightly blood-tinged.
Post-operative care often involves using antibiotic eardrops for a few days to treat any residual infection and ensure the tube remains open and clear. The first follow-up appointment is typically scheduled two to three weeks after surgery to confirm the tubes are functioning correctly and that hearing has improved. Subsequent checks are usually scheduled every four to six months until the tubes fall out.
Long-term care involves discussing water precautions. Modern guidelines are less restrictive than in the past, and earplugs are generally not required for showering or swimming in chlorinated pools. However, they are recommended when swimming in untreated water like lakes or rivers, or when diving deep underwater.
Ear tubes are temporary and are designed to fall out naturally, a process known as extrusion, as the eardrum heals and pushes the tube outward. This usually occurs between 6 and 18 months after placement. In a small number of cases, the tube may remain in place longer than expected and require removal by a specialist. Minor potential complications include a small patch of scarring on the eardrum, called tympanosclerosis, or persistent drainage that may require additional antibiotic drops.