Ear Tube (Tympanostomy Tube) Placement
What is ear tube placement?
Ear tube placement is a surgery to treat chronic middle ear infection (acute otitis media) and/or fluid buildup (otitis media with effusion). These conditions can lead to hearing loss, speech problems, and ear structure damage.
Ear tube placement involves placing tiny cylinder tubes made of metal or plastic through the eardrum (tympanic membrane). Tubes improve airflow in the ear and normalize ear pressure. The medical term for ear tubes is tympanostomy tubes.
Ear tube placement is a common surgery but it has risks and potential complications. Your child may have less invasive treatment options. Consider getting a second opinion about all the treatment choices before having ear tube placement.
Why is ear tube placement performed?
Your doctor may recommend ear tube placement to treat chronic middle ear infection and/or fluid buildup. Your child's doctor may only consider ear tube placement for your child if other treatments that involve less risk of complications have been ineffective. Ask your doctor about all of your child’s treatment options and consider getting a second opinion before deciding on ear tube placement.
Ear tube placement treats the following conditions:
Chronic and severe middle ear infection and/or fluid buildup that does not improve with other treatments
Eardrum or eustachian tube malformation associated with genetic conditions such as Down syndrome and cleft lip
Hearing loss or speech delay due to fluid buildup in the middle ear
Injury to the middle ear due to a reduction of air pressure, which can occur when flying or scuba diving
Who performs ear tube placement?
An otolaryngologist or pediatric otolaryngologist performs ear tube placement. Otolaryngologists specialize in treating conditions of the ears, nose and throat. They are also called ENTs. Pediatric otolaryngologists (pediatric ENTs) specialize in treating ears, nose and throat conditions of infants, children and adolescents.
How is ear tube placement performed?
Your child’s ear tube placement will be performed in a hospital. Your doctor will first use a scalpel or laser to create a small incision in your child's eardrum. This procedure is called a myringotomy.
Fluid behind the eardrum and in the middle ear space is suctioned out and the area cleaned. The doctor will place a small tube in the hole to allow for drainage and ventilation of the middle ear.
Your child's doctor may also remove the adenoids (lymph tissue located in the back of the upper throat near the nose) during ear tube surgery. This may help prevent recurrent ear infections and the need for repeat surgery.
Types of anesthesia that may be used
Children having ear tube placement surgery generally have general anesthesia. General anesthesia includes an inhaled gas and possibly intravenous (IV) medications that put your child in a deep sleep. Your child is unaware of the procedure and will not feel any pain.
Adolescents and adults may not require anesthesia for ear tube placement.
What to expect the day of your child's ear tube placement
The day of the procedure, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your child’s care team will provide blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your child's medical history and the type of anesthesia to be used
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your child's anesthesia.
A tube may be placed in the windpipe to protect and control breathing during general anesthesia. Your child will not feel or remember this or the surgery as they happen.
The surgical team will monitor your child's vital signs and other critical body functions. This occurs throughout the procedure and your child's recovery until your child is alert, breathing effectively, and the vital signs are stable.
What are the risks and potential complications of ear tube placement?
As with all surgeries, ear tube placement involves risks and potential complications. Most ear tube placement surgeries are successful, but complications may become serious in some cases. Complications can develop during the surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of ear tube placement
Complications of ear tube placement include:
Additional surgery, if the ear tube falls out too soon or fluid buildup returns in the middle ear
Blockage of the tubes with blood or other secretions
Infection in the middle ear or around the ear tube
Perforation of the eardrum requiring additional surgery
Scarring in the ear due to repeated ear tube surgeries
Reducing your child's risk of complications
You can reduce your child's risk of some complications by following the treatment plan and:
Ensuring your child follows activity, dietary and lifestyle restrictions and recommendations before the procedure and during recovery. For example, your child may need to wear an earplug when bathing or swimming to keep their ear dry after surgery.
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Giving medications exactly as directed
Telling all members of the care team if your child has any allergies
How do I prepare my child for ear tube placement surgery?
You are an important member of your child's healthcare team. The steps you take before surgery can improve your child's comfort and outcome.
You can prepare your child for ear tube placement by:
Answering all questions about your child's medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your or your child's medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your child's age and general health. Testing may include blood tests, a hearing test, and other tests as needed.
Not allowing your child to eat or drink prior to surgery as directed. Surgery may be cancelled if your child eats or drinks too close to the start of surgery because your child can choke on stomach contents during anesthesia.
Following medication guidelines as directed. This may include not giving your child aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your child's doctor will give you instructions about what medications your child can take.
Questions to ask your child's doctor
Facing surgery can be stressful, especially when it is for your child. It is common for parents to forget some of their questions during a doctor’s office visit. You may also think of other questions after the appointment. Contact your child’s doctor with concerns and questions before ear tube placement and between appointments.
It is also a good idea to bring a list of questions to your child's appointments. Questions can include:
Why does my child need ear tube placement surgery? Are there any other options for treating my child?
How will you perform the surgery?
If you find a problem or another condition during surgery, will you treat it right away or will my child need more surgery later?
How long will the surgery take? When can my child go home?
What restrictions will my child have after surgery? When can normal activities be resumed?
What medications will my child need before and after the surgery?
Will my child have pain after the procedure? If so, how will it be treated?
When should my child see you for follow-up after surgery?
When and how should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my child's ear tube placement surgery?
Knowing what to expect can help make your child's road to recovery after ear tube placement go as smooth as possible.
How long will it take to recover?
Ear tube placement is a quick procedure. It generally takes less than 15 minutes. Your child will stay in the recovery room after surgery until he or she is alert, breathing effectively, and vital signs are stable. Most children go home the same day of surgery.
Your child may feel tired, irritable, and/or nauseous when awakening from anesthesia. These side effects are normal and go away quickly. Your child may have a sore throat if a tube was placed in the windpipe during surgery. This is usually temporary, but tell your care team if your child is uncomfortable.
Recovery following ear tube placement is quick. Your child should be able to return to normal activities the day after ear tube placement. If the adenoids were removed, your child will need to take it easy for about a week following surgery. Your child may also need antibiotic eardrops for a few days following surgery.
Surgery to remove the ear tube usually isn't necessary. The ear tube usually falls out on its own as the hole in the eardrum heals. The tube will stay in place for 6 to 18 months, depending on the type of tube.
It is important to keep your child's follow-up appointments and get all needed testing after surgery. Testing may include an audiogram to check for improved hearing.
Will my child feel pain?
Pain control is important element for healing and a smooth recovery. Most children feel little to no pain following ear tube placement. Call the doctor if your child is uncomfortable. Your child's doctor will treat your child's pain as needed. Call the doctor if your child’s pain gets worse or changes in any way because it may be a sign of a complication.
When should I call the doctor?
It is important to keep your follow-up appointments after ear tube placement. Contact your doctor for questions and concerns between appointments. Call the doctor right away if your child has any of the following:
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow the doctor's specific instructions about when to call for a fever.
Ear swelling or feeling of fullness in or around the ear
Pain that is not controlled by pain medication or lasts longer than seven days after surgery
Drainage or blood from the ear that lasts longer than expected after surgery. Your doctor will tell you how much drainage is expected.
Tube falls out unexpectedly
How might ear tube placement affect my child's everyday life?
Ear tube placement can resolve your child's ear infections and/or fluid buildup problems. This includes eliminating the pain and fever that typically accompanies infection and hearing loss and ear damage that can occur.