Ear Tubes: What They Are and How They Work

Most children will experience at least one ear infection by age 5, and children who experience multiple ear infections in a short span of time may be candidates for ear tubes.

Ear tubes, also called tympanostomy tubes or pressure equalization tubes (PE tubes), are used to prevent recurrent ear infections and reduce the need for antibiotics. Most commonly recommended for infants or children with repeated middle ear infections, ear tubes help prevent complications from long-term fluid accumulation in the middle ear space, such as hearing loss and speech problems.

Made of plastic, metal or Teflon, an ear tube is just a few millimeters in length and has an opening approximately 1 millimeter wide. It is inserted into the eardrum to act as a pressure-release valve for the middle ear.

If ear tubes are a consideration, your child will be referred to an ear, nose and throat specialist, also known as an otolaryngologist. After the initial consultation, the ear, nose and throat doctor may decide to monitor your child over time to see if tubes are necessary or may proceed with tube placement.

How Ear Tubes Work
Ear tubes allow air to enter and fluid to drain out of the middle ear. The middle ear space transmits information from the eardrum to the inner ear. To function properly, the middle ear needs to be filled with air; however, the middle ear lining is constantly absorbing this air.

The eustachian tube connects the middle ear space to the back of the nasal passages and replaces the absorbed air. In children, the eustachian tubes are easily blocked due to their size and shape, particularly when there is swelling in the back of the nose from a cold or allergies.

When the eustachian tube is blocked, negative pressure builds up in the middle ear, and secretions and bacteria from the nasal passages are then pulled into the middle ear space, which can lead to an infection. Ear tubes help to ventilate the middle ear so that fluid buildup and ear infections are less likely.

How Are Ear Tubes Inserted?
Ear-tube surgery is an outpatient procedure. Children are given general anesthesia by face mask and breathe on their own during the procedure. A small opening is made in the eardrum, fluid is suctioned out of the middle ear space, and then the tube is inserted in the opening. The actual procedure only lasts approximately 5 to 10 minutes. Parents should expect about an hour of recovery room time, and the child will be able to resume normal activities within 24 hours. Regularly scheduled follow-up appointments are important to ensure proper function of the tubes.

What to Expect After Surgery
Children can usually maintain normal activities with ear tubes. Swimming in contaminated water such as lakes or ponds is discouraged, and children should not swim to depths that would put pressure on their eardrums. You can discuss water activities and the need for earplugs with your physician.

Most children will experience drainage from the ear tube some time after insertion. This is often a minor version of an ear infection and does not produce pain or fever. Ear tubes reduce, but do not completely eliminate, ear infections. Children may still get an ear infection if the tubes are blocked or if there is thick middle ear fluid. In this case, oral antibiotics may be prescribed.

Most ear tubes are short-term tubes, designed to fall out in 6 to 12 months.  In some cases, the tubes may fall out too early or may stay in too long and need to be removed. In rare cases, a tube can leave a small hole in the eardrum that needs to be repaired. Other possible complications include scarring or thinning of the eardrum where the tube was placed. The tube may also become blocked with dried fluid. Often blocked tubes can be cleared with ear drops or with special tools used by the otolaryngologist.

How Can I Prevent Ear Infections?
Breastfeeding, avoiding cigarette smoke, vaccinating against influenza and pneumococcus (the most common bacterial cause of ear infections), and minimizing exposure to others with respiratory infections are all recommended prevention strategies.

Dr. Elizabeth Long is a resident pediatrician at Carolinas Medical Center, and Dr. Erin Stubbs is a board-certified pediatrician at CMC Myers Park Pediatrics.

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