If you or your child has an ear infection or fluid buildup in the middle ear, your doctor may recommend ear tube surgery to help prevent future problems.

Ear tubes are small, hollow cylinders made from plastic or metal that are surgically placed in the eardrum by an ear, nose and throat (ENT) doctor. Ear tubes aren’t permanent and usually fall out on their own.

Ear tube surgery can be done at any age and is one of the most common surgeries in young children between the ages of 1 and 3 years old.

Here’s when you might need ear tubes, how they help and what to expect before, during and after ear tube surgery.

When would you or your child need ear tubes?

Ear tubes are used to treat infection and fluid buildup in the middle ear. Your doctor may recommend ear tubes if other ear infection treatments don’t work, or your symptoms don’t go away or keep coming back. Your doctor may also recommend ear tubes in the following situations:

Chronic middle ear infection

If a middle ear infection doesn’t go away within three months, it’s usually considered chronic. In this case, your doctor may recommend ear tube surgery, especially if there are signs of hearing loss.

Recurrent middle ear infections

If you or your child have frequent middle ear infections, your doctor may recommend ear tube surgery to help prevent new infections. So, how many ear infections before ear tubes are recommended? The general rule is three separate infections in six months or four infections in one year.

Fluid buildup in the middle ear

You can have fluid buildup in your middle ear without an infection. Even if there’s no infection, this extra fluid can be damaging, leading to a ruptured eardrum, speech problems and permanent hearing loss. If there’s fluid in the ear that hasn’t gone away in three months, your doctor may recommend ear tubes.

Chronic inflammation in the middle ear

If the middle ear is always inflamed, it can lead to hearing loss, delayed development, a tear in the eardrum and chronic discharge. If you or your child has ongoing middle ear inflammation, your doctor may recommend ear tube surgery to prevent new infections, or ear endoscopy surgery to repair the eardrum.

How ear tubes help

There are a few ways that ear tubes help with middle ear problems, including:

  • Improved fluid drainage and ventilation– Ear infections are more common in small children because the Eustachian tubes in their ears are shorter, narrower and more likely to get clogged. Ear tubes allow fluid to drain and for air to reach the middle ear, reducing the recurrence of infections.
  • Less ear pressure and pain– Ear pain can happen when fluid collects in your middle ear and pushes against your eardrum. Because ear tubes allow fluid to drain from the middle ear, they can relieve ear pain and that clogged-up feeling.
  • Better hearing– Fluid that collects behind the eardrum can make it hard to hear. If a child has hearing loss because of an ear infection, it can lead to developmental delays. By improving hearing, ear tubes can help your child reach key milestones sooner.

What happens before, during and after ear tube surgery

Ear tube surgery is one of the most common medical procedures performed in the U.S. It’s also a simple, quick procedure that’s easy to prepare for and recover from. Below, learn what you can expect before, during and after an ear tube procedure.

Before the procedure

Little preparation is needed before ear tube surgery. In some cases, you’ll just need to show up at the required time. But if your doctor is using a general anesthetic for the procedure, you or your child will need to fast before the procedure. Your doctor will provide specific instructions based on your child’s age and diet.

What kind of anesthesia is used for ear tube surgery?

The type of anesthesia that’s used typically depends on the age of the patient and the type of ear tubes they need. For adults, a topical anesthesia is generally used, but kids are given general anesthesia so they can sleep during the surgery. Talk to your doctor to see what options are available for you or your child.

During the procedure

The actual ear tube surgery is very quick. During the procedure, the doctor:

  • Makes a small cut in each eardrum, either with a scalpel or a laser, allowing any fluid behind the eardrum to drain.
  • Suctions out the fluid as it flows into the ear canals.
  • Inserts the ear tubes into the eardrum incisions.

After the procedure

In most cases you’ll be able to go home the same day – usually within 1-2 hours after the surgery. And everyone should be back to normal activities within 24 hours.

There might also be some ear drainage, but that will be gone within a couple of days. If there’s ear pain, over-the-counter medication like acetaminophen (Tylenol) or ibuprofen (Advil) will likely help ease any discomfort.

Your doctor will also provide additional care instructions and tell you when to make a follow-up appointment.

Are there risks to ear tube surgery?

As with any procedure, ear tube surgery can have risks. Possible complications with ear tubes include:

  • Ongoing drainage of fluid from the ear, a condition known as otorrhea.
  • The hole doesn’t heal when the tubes fall out, and you’ll need another surgery to repair it.
  • Scarring or damage to the eardrum, resulting from the surgery or from having frequent ear infections. Very rarely, this can cause changes in hearing.

What to expect once you have ear tubes

Once the ear tubes are in place, what can you expect? Here are answers to common questions:

When will hearing come back after ear tube surgery?

If you or your child suffered hearing loss related to a middle ear infection, your hearing might get better right away, but it usually takes about two weeks to notice a significant improvement. Also, hearing after ear tube surgery can be sensitive – avoiding loud noises for a few weeks can help your ears as they heal.

Do you need to wear earplugs when swimming or bathing after getting ear tubes?

It’s best to keep water out of your ears after ear tube surgery, especially for the first few weeks. If you are okay with wearing earplugs when bathing and swimming, that’s the safe way to go. But wearing earplugs isn’t always fun and it can be a struggle getting your kids to wear them. It’s okay to skip them in some situations, but there are times when you should do your best to see that they’re worn. These times include:

  • When diving deep or swimming under water. Swimming down two feet or more can increase the water pressure in your ears, forcing water through the ear tubes and into the middle ear.
  • If you’re swimming in a lake, river, pond or ocean. These types of water may introduce bacteria into the ear, increasing the chance of a bacterial ear infection

If you have questions about when to wear earplugs after ear tube surgery, talk to your doctor.

When do ear tubes fall out?

Ear tubes typically fall out after 6-18 months as a result of the ear’s natural healing process. When the ear repairs the incision in the eardrum, it squeezes the ear tube, causing it to fall out. Occasionally, ear tubes don’t fall out on their own. If this happens, your doctor may leave them in place for a few years before removing them.

So, what does it feel like when the ear tubes fall out? You probably won’t feel anything. Often people don’t even know when the tubes fall out because they get caught in ear wax – and they’re so tiny you don’t even know they’re there. You might only find out they’ve fallen out during a follow-up appointment when your doctor looks in your ears.

After the tubes fall out, watch for symptoms of ear infection and fluid buildup. If you or your child continue to have middle ear problems, your doctor may recommend having ear tube surgery again.

Can you still get ear infections with ear tubes?

Though it doesn’t happen often, it’s possible to get an ear infection with ear tubes. But if you or your child gets an ear infection after the surgery, it probably won’t be as bad. Ear tubes allow the fluid, and infection, to drain from the ear, so you’re less likely to have ear pain and hearing loss.

Alternatives to ear tubes

You may be wondering, can ears drain without tubes? Are there other treatments that work?

While there are many ways to treat ear infection symptoms, you’re likely looking into ear tubes because you or your child has chronic or recurring middle ear problems that haven’t been helped by antibiotics or other at-home treatments. If other treatments aren’t working, ear tubes are generally recommended as a next step. But here are a couple of other possibilities:

Reducing ear infections

If ear tubes are recommended because of frequent ear infections, another option would be to take steps to reduce how many ear infections you or your child gets. However, even if you do all of the following recommendations, there’s no guarantee that you won’t have ear infections.

Things that can help reduce the chance of ear infections in your child:

  • Reduce the number of other children your child comes into close contact with, so they’re exposed to fewer germs.
  • Breastfeed so they get the immune system boost from breast milk.
  • Feed them in an upright position so fluids don’t back up in their ears while they’re eating.
  • Wean them off their pacifier at around 6 months – sucking on one can interfere with how their Eustachian tubes work.

Things that can help reduce the chance of ear infections for both of you:

  • Wash hands regularly to avoid getting sick.
  • Get your flu shot and other vaccinations.
  • Stay away from cigarette smoke.

Ear tube questions? We’re all ears.

Ear tube surgery can be very beneficial if you or your child has chronic or recurring infections or fluid buildup in the middle ears. And our expert team of board-certified ENT doctors are ready to ensure the best outcomes for you and your family.

You don’t need a referral, so consider making an appointment with an ENT doctor if you or your child have:

  • Three ear infections in six months or four in a year
  • Severe ear pain
  • Hearing loss
  • Symptoms that continue after you’ve finished antibiotics

Are ear tubes right for you or your child?