Tympanostomy tubes, often called ear tubes, are small, hollow cylinders surgically inserted into the eardrum to manage recurrent middle ear infections or persistent fluid buildup. The presence of drainage is the most common symptom when tubes are in place. This discharge indicates that the tubes are open and functioning as a vent for the middle ear space.
Understanding Drainage: The Role of Ear Tubes
Tympanostomy tubes are inserted to bypass the Eustachian tube, the body’s natural pressure equalization and drainage system for the middle ear. In young children, this tube is often narrower and more horizontal, making it prone to blockage by swelling from colds or allergies. When the Eustachian tube fails to open, air pressure cannot be equalized, and fluid accumulates behind the eardrum, potentially leading to infection or hearing loss.
The ear tube creates a small, direct opening through the eardrum, allowing air to circulate and fluid to exit the middle ear space into the ear canal. This relieves pressure and prevents the painful bulging of the eardrum. When infection or inflammation occurs, the fluid is able to drain out of the ear rather than remaining trapped, confirming the tube is performing its ventilation and drainage function.
Common Causes of Fluid Drainage
The most frequent reason for discharge when an ear tube is present is a new acute middle ear infection, known as acute otitis media (AOM). In a child without tubes, AOM typically causes severe pain because the pus and fluid are trapped, putting pressure on the eardrum. With a tube in place, that infected material simply drains out, often leading to less discomfort and fewer systemic symptoms like fever.
This drainage can vary widely in appearance, ranging from thin and clear or yellowish to thick, opaque, and green or white, often resembling pus. The discharge may also appear bloody or have a foul odor, which is usually a strong indicator of a bacterial infection in the middle ear. The infection may be caused by common respiratory viruses or bacteria that travel up the Eustachian tube from the nose and throat.
Another common cause of drainage relates to exposure of the ear canal to external contaminants. Water that enters the ear canal during bathing, swimming, or while playing in a pool can sometimes introduce bacteria. This can lead to an infection of the ear canal skin, called otitis externa, or “Swimmer’s Ear,” which may cause a whitish, watery discharge.
In some cases, the tube itself can become irritated or temporarily blocked, and when it opens again, a small amount of clear or cloudy fluid may drain out.
Drainage can also be a result of non-infectious inflammation associated with a common cold, seasonal allergies, or even irritation from soaps or shampoos. When the lining of the nose and throat swells from these conditions, the Eustachian tube can also become inflamed, causing fluid to collect in the middle ear. This sterile fluid, or effusion, then drains out through the tympanostomy tube.
When to Contact a Healthcare Provider
Parents should monitor the amount, color, and duration of the ear drainage to determine if medical attention is necessary. Clear or slightly cloudy drainage that occurs once or twice, especially after water exposure or a cold, may resolve on its own.
Contact a healthcare provider if the child experiences:
- Discharge that is thick, yellow, green, or brown, or that has a strong, foul odor, suggesting a bacterial infection.
- Frank blood or persistent bloody drainage lasting more than a few days.
- A significant change in behavior, such as increased fussiness, severe pain, or a fever above 100.4°F (38°C).
- Drainage that persists for more than five to seven days, even if clear.
Treatment for drainage through a tube is typically managed differently than a standard ear infection. The first-line therapy is often antibiotic ear drops, such as those containing ciprofloxacin and dexamethasone, which deliver medication directly to the middle ear space through the tube. This topical application is highly effective and avoids the systemic side effects associated with oral antibiotics.
Parents should report any suspicion that the ear tube has fallen out, as this can cause the drainage to stop suddenly, but may lead to a recurrence of the original middle ear problems. If the drainage does not improve within two to three days of starting the prescribed ear drops, or if the child develops noticeable swelling or redness around the outer ear, a follow-up appointment is necessary.