Ear Infections and Ear Tubes

Reasons for ear tubes in children with ear infections

Female doctor looking into baby boy's ear considering ear tubes
What should your child get ear tubes for ear infections?. Cultura Science/Sigrid Gombert/Riser/Getty Images

Does your child need ear tubes for ear infections?  When is the time right, what are some of the conditions doctors think about in making this important decision, and what are the benefits and risks of this surgery?

Recurrent Ear Infections

Fortunately, most kids only get a few ear infections (otitis media) a year. But it can be frustrating when they keep getting ear infections over and over again.

Are ear infections going to damage your child's hearing or delay their talking?

How many ear infections are too many?

When do you need to get ear tubes?

Indications for Ear Tubes

Ear tube or tympanostomy tube placement surgery is the most common elective surgery in children in the United States and is done for recurrent ear infections, or for an ear infection that does not clear after a period of time with appropriate antibiotics.

As far as an absolute number of ear infections, many experts would consider tubes for a child who has had three ear infection in six months or four ear infections in 12 months. Other experts use much more general guidelines and would place tubes when infections are frequent and close together.

Having fluid in their ears (otitis with effusion) for more than three months and hearing loss is another reason children get tubes. In other words, it's not recommended that tubes be placed for children who have a single episode of otitis media with effusion lasting less than 3 months. If the infection lasts longer than 3 months, hearing should be tested. If hearing is decreased, parents should then be offered the option of tube placement. If tubes are not placed, the child should be re-evaluated at least every 3 months until the effusion (fluid) clears, or there is evidence of hearing loss or structural abnormalities of the eardrum.

Other Reasons to Consider Ear Tubes

In addition to the number of ear infections a child has or how long they have fluid in their ears, a few other things might influence you to have your child get tubes early. These include having risk factors that make it likely that your child will continue to get a lot of ear infections in the future, including being a boy who is under 2 years old and who attends daycare (daycare syndrome), especially if getting a lot of ear infections runs in the family (genetic factors).

The 'type' of ear infections your child gets might also influence your decision to get tubes. If your child's ear infections are very painful, take more than a few days to get over, or they take multiple rounds of antibiotics to clear, then you might want to get tubes earlier than if your child's ear infections were not painful or quickly cleared up.

The time of year might also influence your decision about tubes. Even if your child has recently had a lot of ear infections, if it is April or May, you wouldn't expect her to continue to get sick as much throughout the rest of the spring and summer. In this case, you might wait a little longer than you might if your child had already gotten a lot of ear infections going into the winter when she would probably keep getting sick all of the time during cold and flu season.

Keep in mind that the decision on when to get tubes is not as critical as most parents believe. In fact, one study showed that 'in children younger than 3 years who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 3 years.'

So the timing of when to get ear tubes is not always as clear cut as you might think.

Benefits of Ear Tubes

By far the most important benefit of ear tubes is something that has been found in many studies: ear tubes improve the quality of life for many children.  When done appropriately, ear tubes can improve hearing, which can, in turn, improve learning and behavior.

Risks of Ear Tubes

Complications may occur with any procedure performed in medicine. Most of the following complications do not occur and keep in mind that most children do not have all of these complications. Possible complications of ear tube surgery include:

  • Loss of the tubes - Sometimes the tubes fall out early when they are still needed
  • Blockage of the tubes is the most common complication, occurring in around 10% of children
  • Drainage from the tubes (otorrhea) - While annoying, drainage from ear tubes can be treated with topical drops and does not usually require oral antibiotics
  • Granulomas - Scar tissue formation in the eardrum
  • Cholesteatomas
  • Tympanic membrane perforation

Prevention of Ear Infections

The best treatment is almost always prevention, and if you can reduce the number of ear infections for your child, you may lower the chances that she will need ear tubes. Certainly, this is not always possible, and even the most attentive and caring parents frequently have children who end up needing ear tubes.  Some measures that may possibly make a difference include:

  • Breastfeeding
  • Reducing or eliminating exposure to secondhand smoke
  • Reducing pacifier use
  • Keeping your child from drinking from a bottle while lying down
  • Reducing exposure to others who are ill

What You Need to Know

  • If you think your child has had too many ear infections, then ask your pediatrician for a referral to a pediatric ENT specialist to discuss if ear tubes would be appropriate.
  • On the other hand, if your pediatrician recommends tubes but you are hesitant to have surgery, then ask if it would be appropriate to wait a little longer.
  • If your child is diagnosed with an ear infection, is put on antibiotics and is still having pain and fever a week later, that technically still counts as the same ear infection. And keep in mind that they can then have fluid in their ears for 2 to 3 months, which is often misdiagnosed as an ear infection. If you go back for a recheck and your child has no symptoms at all, but your are told he has an ear infection, you might get a second opinion from a pediatric ENT specialist to see if it is just fluid.
  • Although some children have complications after getting tubes, numerous studies have shown improved quality of life outcomes for children after getting tubes.
  • Take some steps to control the things that put kids at risk for ear infections.
    View Article Sources
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    • Rettig, E., and . Tunkel. Contemporary concepts in management of acute otitis media in children. Otolaryngology Clinics of North America. 2014. 47(5):651-72.
    • Rosenfeld, R., Schwartz, S., Pynnonen, M. et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngology – Head and Neck Surgery. 2013. 149 (1 Suppl):S1-S35.
    • Rosenfelt, R., Shin, J., Schwartz, S. et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology – Head and Neck Surgery. 2016. 154(1 Suppl):S1-S41.