Ear Tubes: Complete Guide to Myringotomy Surgery
📊 Quick Facts About Ear Tubes
💡 Key Points About Ear Tubes
- Quick and safe procedure: Ear tube insertion takes only 10-15 minutes and is one of the most common pediatric surgeries worldwide
- Immediate hearing improvement: Many children experience better hearing right after surgery as fluid drains from the middle ear
- Natural expulsion: Tubes typically fall out on their own after 6-18 months as the eardrum heals
- Swimming is usually allowed: Surface swimming is generally safe; deep diving should be avoided
- Low complication rate: Serious complications are rare, though some children may need repeat procedures
- Children under general anesthesia: Children are put to sleep for the procedure; adults may receive local anesthesia
What Are Ear Tubes and Why Are They Needed?
Ear tubes are tiny cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum (tympanic membrane) to allow air to flow into the middle ear and fluid to drain out. They are primarily used to treat recurrent ear infections (acute otitis media) and persistent fluid behind the eardrum (otitis media with effusion).
The medical name for ear tube surgery is myringotomy with tympanostomy tube insertion. In some countries, these tubes are called grommets, ventilation tubes, or PE (pressure equalization) tubes. This procedure is one of the most commonly performed pediatric surgeries worldwide, with millions of children receiving ear tubes each year.
Understanding why ear tubes are needed requires knowledge of how the ear works. The middle ear is a small air-filled space behind the eardrum that contains the tiny bones (ossicles) responsible for transmitting sound vibrations. Normally, the Eustachian tube connects the middle ear to the back of the throat and allows air to enter, keeping pressure equalized. In children, this tube is shorter, more horizontal, and more prone to blockage than in adults, which is why ear problems are so common in young children.
When the Eustachian tube doesn't function properly, air cannot enter the middle ear, creating negative pressure that draws fluid from the surrounding tissues. This fluid can become infected, leading to acute ear infections, or it can persist without infection, causing hearing problems. Ear tubes bypass the malfunctioning Eustachian tube by providing an alternative pathway for air to enter the middle ear.
Ear Infections (Acute Otitis Media)
Ear infections are extremely common in children, often occurring alongside or shortly after a cold or upper respiratory infection. During an ear infection, bacteria or viruses cause inflammation and fluid buildup in the middle ear. The eardrum becomes red, swollen, and bulges outward due to pressure from the accumulated pus or fluid. This causes significant pain and temporary hearing loss.
While most ear infections resolve on their own or with antibiotic treatment, some children experience frequent recurrences. The generally accepted criteria for considering ear tubes include three or more ear infections within six months, or four or more infections within twelve months. Children who experience severe infections, infections that don't respond well to antibiotics, or complications from ear infections may also be candidates for tubes.
Otitis Media with Effusion (Glue Ear)
Otitis media with effusion (OME), sometimes called "glue ear" or secretory otitis, refers to fluid that accumulates behind the eardrum without signs of acute infection. This fluid is not pus and doesn't indicate an active infection. OME commonly develops after a cold or ear infection resolves, but the fluid remains trapped in the middle ear because the Eustachian tube is not functioning well enough to drain it.
The fluid dampens the eardrum's ability to vibrate normally in response to sound waves, causing a sensation of fullness in the ear and temporary hearing loss, typically in the range of 20-30 decibels. While this may seem mild, it can be significant for young children who are developing language and learning to communicate. If OME persists for three months or longer, especially if it's causing noticeable hearing difficulties affecting speech development or school performance, ear tubes may be recommended.
How Ear Tubes Help
Ear tubes serve two main purposes. First, they allow air to enter the middle ear, which helps equalize pressure and allows the eardrum to move freely. This immediately improves hearing in most cases. Second, they provide a pathway for fluid to drain out of the middle ear rather than remaining trapped behind the eardrum. Even if a child develops an ear infection with tubes in place, the infection is typically less painful because the pus can drain through the tube rather than building up pressure against the eardrum.
Ear tubes are extremely small, typically measuring only 1-3 millimeters in diameter. Despite their tiny size, they can make a dramatic difference in a child's hearing and comfort. The tubes are not visible from the outside and don't interfere with normal activities once healing is complete.
Who Needs Ear Tubes?
Ear tubes are typically recommended for children who experience three or more ear infections in six months, four or more in twelve months, or persistent fluid behind the eardrum for three months or longer causing hearing loss. Adults may also benefit from ear tubes in certain situations.
The decision to recommend ear tubes is based on several factors, including the frequency and severity of ear problems, the impact on hearing and development, and the child's response to other treatments. An ear, nose, and throat (ENT) specialist, also called an otolaryngologist, will typically evaluate the child before recommending surgery.
According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guidelines, children who meet the following criteria may be candidates for ear tube placement:
- Recurrent acute otitis media: Three or more episodes of ear infection within six months, or four or more episodes within twelve months, with at least one episode in the preceding six months
- Otitis media with effusion lasting 3+ months: Persistent fluid in one or both ears for at least three months, especially if accompanied by hearing loss of 20 decibels or more
- At-risk children with OME: Children who have speech, language, or learning delays and have OME, even if duration is less than three months
- Complications from ear infections: Children who have experienced complications such as hearing loss, speech delays, balance problems, or structural changes to the eardrum
Children at Higher Risk
Certain groups of children are at higher risk for ear problems and may benefit from earlier intervention with ear tubes. These include children with Down syndrome, cleft palate, or other craniofacial abnormalities, as these conditions affect the structure and function of the Eustachian tube. Children in daycare settings are exposed to more respiratory infections and may have more frequent ear problems. Children with a family history of chronic ear disease or those exposed to secondhand smoke also have increased risk.
Adults and Ear Tubes
While ear tubes are most commonly placed in children, adults can also benefit from this procedure in certain situations. Adults may need ear tubes if they have chronic Eustachian tube dysfunction that causes persistent fluid accumulation, negative middle ear pressure, or retraction of the eardrum. Unlike children, adults typically receive the procedure under local anesthesia rather than general anesthesia, as they can remain still during the brief surgery.
Adults often develop Eustachian tube problems when they are unable to equalize pressure during activities like flying or scuba diving. Some adults develop chronic OME due to allergies, reflux, or anatomical factors. In these cases, ear tubes can provide relief and prevent complications such as hearing loss or cholesteatoma formation.
How to Prepare for Ear Tube Surgery
Preparation for ear tube surgery involves a pre-operative examination with hearing test, following fasting guidelines for children receiving general anesthesia, and avoiding certain medications like ibuprofen for one week before surgery. Children should not have active cold symptoms on the day of surgery.
Proper preparation helps ensure a smooth surgical experience and optimal outcomes. The preparation process differs somewhat between children (who typically receive general anesthesia) and adults (who may receive local anesthesia).
Pre-operative Evaluation
Before scheduling surgery, the ENT specialist will examine your child's ears using an otoscope and may use a technique called pneumatic otoscopy to assess how the eardrum moves. A hearing test (audiogram) is usually performed to document the degree of hearing loss and provide a baseline for comparison after surgery. In some cases, a tympanogram, which measures eardrum movement and middle ear pressure, may also be performed.
The doctor will review your child's medical history, including any previous ear infections, allergies, previous surgeries, or reactions to anesthesia. Be prepared to provide a complete list of any medications, supplements, or herbal remedies your child takes regularly.
Fasting Guidelines
Children receiving general anesthesia must fast before surgery to reduce the risk of aspiration (inhaling stomach contents into the lungs). Specific fasting times vary by institution, but generally:
- Solid food: No solid food for at least 6-8 hours before surgery
- Formula or milk: No formula or non-breast milk for at least 6 hours before surgery
- Breast milk: No breast milk for at least 4 hours before surgery
- Clear liquids: No clear liquids (water, apple juice, clear sports drinks) for at least 2 hours before surgery
The surgical center will provide specific instructions tailored to your child's age and scheduled surgery time. Following these guidelines exactly is crucial for safety.
Avoiding Illness
Children with cold symptoms, fever, or respiratory illness on the day of surgery may need to have their procedure postponed. This is because general anesthesia carries additional risks when a child has active respiratory symptoms, including increased airway reactivity and higher risk of complications. Additionally, performing surgery during an active infection can increase the risk of post-operative problems.
If your child develops cold symptoms in the days leading up to surgery, contact the surgical center or your doctor's office for guidance. In many cases, mild symptoms that have been improving may be acceptable, but this decision should be made by the anesthesiologist.
Medications to Avoid
Certain medications should be avoided in the week before surgery because they can increase bleeding risk:
- Ibuprofen (Advil, Motrin) and other NSAIDs
- Aspirin and aspirin-containing products
- Certain herbal supplements such as vitamin E, fish oil, ginkgo, and garlic supplements
If your child needs pain relief or fever reduction before surgery, acetaminophen (paracetamol/Tylenol) is generally safe to use. Always inform the surgeon about any medications your child is taking, including over-the-counter products and supplements.
Be sure to inform your child's surgeon and anesthesiologist about all medications, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Some medications may need to be continued, adjusted, or stopped before surgery.
How Is Ear Tube Surgery Performed?
Ear tube surgery (myringotomy) involves making a tiny incision in the eardrum, suctioning out any fluid, and inserting a small tube. The procedure takes only 10-15 minutes per ear, is performed under general anesthesia for children, and patients typically go home within an hour of waking up.
The surgical procedure for ear tube placement is straightforward and well-established, having been performed millions of times worldwide. Understanding what happens during surgery can help reduce anxiety for both parents and children.
Anesthesia
For children, ear tube surgery is almost always performed under general anesthesia, meaning the child is completely asleep and feels nothing during the procedure. This is necessary because children cannot remain perfectly still for the delicate microsurgery required. General anesthesia for this procedure is very safe, and the anesthesia time is typically very short (15-30 minutes total).
Parents are usually allowed to accompany their child into the operating room and stay until the child falls asleep. This can help reduce anxiety and make the experience less frightening for young children. Once the child is asleep, parents wait in a designated area until the surgery is complete.
Adults undergoing ear tube placement often receive local anesthesia only, which numbs the eardrum while the patient remains awake. This is possible because adults can cooperate with instructions to remain still during the brief procedure. Some adults may receive light sedation in addition to local anesthesia if they feel anxious about the procedure.
The Surgical Steps
The surgeon follows a precise sequence of steps to place the ear tube:
- Ear canal cleaning: Any earwax buildup is removed so the surgeon has a clear view of the eardrum
- Microscope positioning: The surgeon uses an operating microscope to magnify the view of the eardrum
- Myringotomy incision: A tiny incision (approximately 2-3 mm) is made in the eardrum using a specialized blade
- Fluid removal: Any fluid behind the eardrum is suctioned out through the incision
- Tube insertion: The ear tube is carefully placed into the incision so it sits in the opening with part of the tube inside the middle ear and part in the ear canal
- Ear drop application: Antibiotic and/or steroid ear drops are placed to prevent infection and reduce inflammation
The entire procedure typically takes only 10-15 minutes per ear. If both ears need tubes, the total operating time is usually less than 30 minutes.
Types of Ear Tubes
Ear tubes come in different shapes and materials, and the surgeon will choose the most appropriate type based on the patient's specific situation:
| Type | Material | Duration | Best For |
|---|---|---|---|
| Short-term tubes | Plastic, titanium, or fluoroplastic | 6-18 months | Most children with recurrent infections or OME |
| Long-term (T-tubes) | Silicone or titanium | 2-4 years | Children who need tubes again or have severe problems |
| Grommet-style | Various materials | Variable | Standard choice in many countries |
Going Home
Ear tube surgery is an outpatient procedure, meaning patients go home the same day. After surgery, children are taken to a recovery area where they are monitored as they wake from anesthesia. This recovery period typically takes 30-60 minutes. Children may be groggy, irritable, or confused immediately after waking, but these effects resolve quickly.
Most children can go home within one to two hours of completing surgery. You will receive instructions about care at home, activity restrictions, and when to schedule a follow-up appointment.
What to Expect After Ear Tube Surgery
Most children feel normal within hours after ear tube surgery with minimal or no pain. Some drainage from the ears is normal in the first few days. Hearing often improves immediately, and regular follow-up visits are needed to check that the tubes are working properly.
Recovery from ear tube surgery is typically quick and smooth. Understanding what to expect can help you care for your child properly and know when something might need medical attention.
Immediate Recovery Period
In the hours following surgery, children may experience:
- Drowsiness or irritability from the anesthesia, which typically resolves within a few hours
- Minor ear discomfort or fullness, though most children report little to no pain
- Mild nausea or vomiting from anesthesia (uncommon)
- Some drainage from the ear canal, which may be blood-tinged or clear
If pain relief is needed, acetaminophen (paracetamol) is usually sufficient and can be given as directed for your child's age and weight. Ibuprofen can typically be resumed a few days after surgery once any bleeding risk has passed.
Most children can eat and drink normally once they are fully awake and alert after anesthesia. Start with clear fluids and progress to regular foods as tolerated.
First Few Days
In the days following surgery, it's normal to see some drainage from the ear. This may be blood-tinged fluid, clear fluid, or yellowish discharge. This drainage represents fluid that was trapped behind the eardrum finally being able to drain out through the tube. It typically decreases over the first few days.
If drainage becomes thick, purulent (pus-like), foul-smelling, or continues for more than a few days, contact your doctor, as this may indicate an infection that needs treatment with antibiotic ear drops.
Most children can return to normal activities, including school or daycare, within one to two days after surgery. Physical activity, including running and playing, can usually resume immediately unless the doctor provides other instructions.
Hearing Improvement
One of the most gratifying aspects of ear tube surgery for parents is the often-dramatic improvement in their child's hearing. If fluid was present behind the eardrum, hearing typically improves immediately after surgery because the fluid is removed and the eardrum can vibrate freely again.
Parents often notice that their child responds better to their name being called, speaks more clearly, or seems more engaged. Children who had hearing loss affecting their speech development may show improvements in language skills over the following weeks and months. A follow-up hearing test is typically performed one to two months after surgery to document the improvement.
Using Ear Drops
Most surgeons prescribe antibiotic ear drops to be used for several days after surgery to prevent infection and help keep the tube clear. To administer ear drops properly:
- Have the child lie on their side with the affected ear facing up
- Gently pull the outer ear up and back (for children over 3) or down and back (for younger children) to straighten the ear canal
- Place the prescribed number of drops into the ear canal
- Gently pump the tragus (the small flap in front of the ear canal) several times to help the drops flow through the tube
- Keep the child on their side for a few minutes to allow the drops to work
- Repeat for the other ear if both ears have tubes
Water Precautions
One of the most common questions parents have concerns water exposure and swimming with ear tubes. Guidelines have evolved over time, and current evidence suggests that water precautions may not be necessary for routine activities like bathing and surface swimming in chlorinated pools.
However, the following precautions are generally recommended:
- Bathing and showering: Generally safe without ear protection; avoid getting soapy water directly into the ears
- Surface swimming: Usually allowed in chlorinated pools without ear plugs for most patients
- Diving: Avoid diving or swimming deeper than 1 meter (3 feet), as water pressure can force water through the tube
- Lake and ocean swimming: Some doctors recommend waterproof ear plugs for swimming in lakes, rivers, or oceans due to higher bacteria levels
Always follow your specific doctor's recommendations, as they may vary based on the type of tube placed and your child's individual situation.
If your doctor recommends water protection, custom-fitted or over-the-counter waterproof ear plugs are available at pharmacies. Look for plugs specifically designed for swimming that create a watertight seal. Some children find swim headbands helpful for keeping plugs in place.
Follow-up Care and Monitoring
Regular follow-up appointments every 4-6 months are important to monitor tube function, check for complications, and perform hearing tests. Most tubes fall out naturally within 6-18 months, and the eardrum heals on its own within a few weeks after tube extrusion.
Ongoing monitoring is an important part of ear tube care. These appointments allow the doctor to ensure the tubes are functioning properly, check for any complications, and track your child's hearing progress.
Regular Check-ups
After ear tube placement, follow-up appointments are typically scheduled every 4-6 months, though the exact frequency may vary based on your child's needs and your doctor's preferences. During these visits, the doctor will:
- Examine the ears with an otoscope to check that the tubes are in place and not blocked
- Look for signs of infection, drainage, or other problems
- Assess hearing and may perform formal hearing tests periodically
- Discuss any concerns or symptoms you've noticed
When Tubes Fall Out
Ear tubes are designed to be temporary and will naturally work their way out of the eardrum over time. Short-term tubes typically fall out within 6-18 months, while long-term T-tubes may remain in place for several years. The tube falls into the ear canal and either falls out of the ear on its own (you may see it on your child's pillow or clothing) or is removed by the doctor during a check-up.
After the tube falls out, the small hole in the eardrum typically heals closed on its own within a few weeks. The doctor will continue monitoring until the eardrum has healed completely.
In some cases, the tube may stay in longer than expected. If a tube remains in place beyond 2-3 years and doesn't appear to be working its way out, the doctor may recommend surgically removing it to allow the eardrum to heal.
Signs That May Need Attention
Contact your doctor if you notice any of the following:
- Persistent drainage lasting more than a few days or recurring frequently
- Foul-smelling discharge from the ear
- Significant ear pain (mild discomfort during a cold is normal)
- Fever along with ear symptoms
- Hearing seems worse than it was after surgery
- The tube is visibly out (you found it or can see it in the ear canal)
What Are the Risks and Complications?
Ear tube surgery is very safe with a low complication rate. Possible complications include persistent ear drainage, early tube extrusion, scarring of the eardrum, and in rare cases a permanent perforation. Serious complications are uncommon, and benefits typically outweigh risks for appropriate candidates.
While ear tube surgery is one of the safest surgical procedures performed, all surgeries carry some risk of complications. Understanding these risks helps you make an informed decision and know what to watch for after surgery.
Common Issues
Otorrhea (ear drainage): Some drainage from tubes is normal, especially in the first few days or during upper respiratory infections. However, persistent or recurrent drainage may indicate an infection. This is usually treated with antibiotic ear drops and resolves with treatment. If drainage doesn't respond to drops, it may indicate that bacteria have formed a biofilm on the tube itself, which may require tube removal.
Tube blockage: Tubes can occasionally become blocked by dried blood, discharge, or earwax. This prevents the tube from functioning properly. Sometimes the blockage can be cleared with ear drops; other times the doctor may need to clean the tube during an office visit.
Early extrusion: Sometimes tubes fall out earlier than expected. If ear problems recur after the tube falls out, a second set of tubes may be recommended.
Less Common Complications
Tympanosclerosis (scarring): Small areas of scarring or calcium deposits on the eardrum can develop in up to 50% of children with tubes. While this sounds concerning, tympanosclerosis rarely causes any hearing problems and usually doesn't require treatment.
Persistent perforation: After a tube falls out, the hole usually heals on its own. In about 1-3% of cases (higher with long-term tubes), the perforation may not close completely. If a persistent perforation causes problems, it can be surgically repaired with a procedure called tympanoplasty.
Atrophy or retraction: The area of eardrum where the tube was placed may become thin (atrophic) or retract inward. This is more common with long-term tubes or after multiple tube placements.
Rare Complications
Cholesteatoma: This is an abnormal skin growth in the middle ear that can develop in rare cases. It requires surgical treatment if it occurs.
Hearing loss: Permanent hearing loss from ear tube surgery is extremely rare. The procedure is performed specifically to improve hearing, not harm it.
Anesthesia complications: While general anesthesia carries some inherent risks, complications from the brief anesthesia required for ear tube surgery are very uncommon in otherwise healthy children.
When considering ear tube surgery, it's important to weigh the risks against the risks of NOT treating recurrent ear infections or chronic fluid, which include ongoing hearing loss, speech and language delays, behavior changes, and potential structural damage to the ear. For most children who meet criteria for tubes, the benefits significantly outweigh the risks.
What If My Child Needs Tubes Again?
Approximately 20-30% of children who receive ear tubes will need a second set, usually within 12-18 months of the first tubes falling out. Children who need multiple sets may be offered longer-lasting tubes and may eventually outgrow the need for tubes as their Eustachian tube function matures.
Some children experience a recurrence of ear problems after their initial tubes fall out. This doesn't mean the first surgery failed - it simply indicates that the underlying Eustachian tube dysfunction is still present. The good news is that most children eventually outgrow these problems as their Eustachian tubes mature, typically by ages 4-8.
If ear infections or fluid recur after tubes fall out, the doctor may initially recommend watchful waiting or medical management. If problems persist and meet the criteria for intervention, a second set of tubes may be placed. For children who need multiple tube placements, the surgeon may recommend long-term T-tubes, which stay in place for several years, reducing the need for additional surgeries.
During repeat tube surgery, the surgeon may also recommend adenoidectomy (removal of the adenoids) if it wasn't performed previously. The adenoids are lymph tissue located behind the nose that can contribute to Eustachian tube blockage and ear problems. Research shows that combining adenoidectomy with tube placement reduces the likelihood of needing additional ear surgeries.
Frequently Asked Questions About Ear Tubes
Medical References
This article is based on peer-reviewed medical literature and international clinical practice guidelines. All medical claims are supported by Level 1A evidence where available.
- Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngology-Head and Neck Surgery. 2022;166(1_suppl):S1-S55. doi:10.1177/01945998221127426
- Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database of Systematic Reviews. 2023. doi:10.1002/14651858.CD001801.pub4
- Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology-Head and Neck Surgery. 2016;154(1_suppl):S1-S41. doi:10.1177/0194599815623467
- American Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3):e964-e999. doi:10.1542/peds.2012-3488
- Steele DW, Adam GP, Di M, Halladay CW, Trikalinos TA. Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics. 2017;139(6):e20170125. doi:10.1542/peds.2017-0125
- World Health Organization. Deafness and hearing loss fact sheet. WHO. 2024. WHO Fact Sheet
About Our Medical Editorial Team
Authors
iMedic Medical Editorial Team
Specialists in Otolaryngology, Pediatric Surgery, and Audiology. Our team includes board-certified physicians with clinical and research experience in ear, nose, and throat conditions.
Medical Review
iMedic Medical Review Board
All content is reviewed according to AAO-HNS Clinical Practice Guidelines 2022, AAP Guidelines, Cochrane Database systematic reviews, and GRADE evidence framework.
Editorial Standards
All medical information on iMedic is written by healthcare professionals and reviewed according to international guidelines. We follow the GRADE framework for evidence assessment and base our recommendations on:
- AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) Clinical Practice Guidelines
- AAP (American Academy of Pediatrics) Guidelines
- Cochrane Database of Systematic Reviews
- WHO (World Health Organization) recommendations
Medical Editorial Board: iMedic has an independent medical editorial board consisting of specialist physicians in otolaryngology, pediatrics, audiology, and general surgery.