Three Signs Your Child Might Need Ear Tubes

When constant ear infections are part of your child’s new normal, antibiotics are always on your shopping list or it seems like your child isn’t hearing as well as they should, it may be time to talk to your pediatrician about ear tubes.

No parent wants to put their child through surgery, but this brief outpatient procedure is more common than most people realize. You can look at almost any person in your life, and there’s a good chance they’ve needed ear tubes at some point during their childhood.

Ear tube surgery, also known as tympanostomy tube insertion surgery, is the most common childhood surgery performed in the United States. At Children’s Hospital of Philadelphia (CHOP), surgeons in the Division of Otolaryngology, commonly known as Ear, Nose and Throat (or ENT), surgically implant ear tubes in more than 4,000 children each year at CHOP’s Main Hospital in Philadelphia, and at CHOP Specialty Care Centers in Brandywine Valley, Bucks County, King of Prussia in Pennsylvania and Voorhees, New Jersey.

Children might need tubes if:

• They have had three or more ear infections within the past six months or four with a year, especially if they retain fluid between the episodes.
• They are suffering from hearing loss caused by the persistent build-up of fluid in the middle ear (otitis media with effusion). Ear tubes can help kids who have fluid that is always present over a period of three months, and that causes diminished hearing.
• They have a collapsed ear drum, a condition known as atelectasis. A collapsed drum that is draped onto the middle ear bones causes decreased hearing. It can also erode the bones in the ear.

Ear tubes are strongly recommended for children experiencing permanent hearing loss or speech concerns. Ear tubes are also recommended for youth who have an increased risk of developmental difficulties, such as children with cleft palate, Down syndrome (trisomy 21), craniofacial syndromes, autism, blindness/visual impairment, intellectual disability, learning disorders or attention-deficit/hyperactivity disorder.

How ear tubes work

Ear tubes ventilate the middle ear space by opening the Eustachian tube, which connects the middle ears to the back of the throat. These tubes open and close to keep the middle ear ventilated and maintain equal pressure. When the Eustachian tube isn’t functioning properly, doctors can make a small opening and place a small artificial tube from the eardrum side.

“I compare a dysfunctional Eustachian tube to a water bottle that has a little bit of water left,” says Kavita Dedhia, MD, MSHP, an otolaryngologist with the Division of Otolaryngology (ENT) at Children's Hospital of Philadelphia. “If you put it in the hot sun, it’s going to steam up because the water bottle is closed. Once you remove the water bottle lid and allow air to move through it, it releases pressure and helps it dry. That is what ear tubes do for your ears – release the pressure and allow air to flow normally.”

Not all children with ear infections require ear tubes, she says.

“Doctors make recommendations, but in the end, this is a shared decision-making process with families,” says Dr. Dedhia. “In the pre-operative office visit we discuss the options of watchful waiting versus surgical management based on the child’s history. Parents can always come to us with questions or concerns.”

What to expect

To insert ear tubes, children must undergo general anesthesia. While anesthesia can be concerning to parents, ear tube insertion is generally a simple and straightforward procedure. In most cases, the procedure takes between 5 and 10 minutes to perform, and recovery is just as quick, Dr. Dedhia says.

Typically, the procedure does not cause pain to the child, Dr. Dedhia says. “Even later that afternoon, most kids appear like they haven’t had any procedure at all.”

Parents can expect some ear drainage after the procedure, and doctors may recommend ear drops twice a day.

Ear tubes typically stay in for an average of 6 to 18 months before they fall out naturally. Some children may require more than one set of ear tubes placed – over time – if hearing issues or infections persist.

Kavita Dedhia, MD, MSHP, is an attending otolaryngologist with the Division of Otolaryngology (ENT) at Children’s Hospital of Philadelphia. Karen B. Zur, MD, is Chief of the Division of Otolaryngology at CHOP.