How to Know If Your Child Needs Ear Tubes

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Fortunately, most kids only get a few ear infections (called otitis media), if any, per year. But if your child gets recurrent infections, your pediatrician may recommend inserting ear tubes. Here's what to know about how many infections warrant tubes, what your healthcare provider will take into consideration when suggesting them, and how to weigh the benefits and risks of this surgery.

Doctor examining a toddler's ear
Cultura Science / Sigrid Gombert / Riser / Getty Images

Why Babies and Children Are Prone to Ear Infections

Babies and children are at higher risk of getting ear infections than adults because:

  • They have shorter, more horizontal, and narrower eustachian tubes, making them less likely to drain effectively, causing a back-up of fluid in the ear.
  • Their immune systems are still developing, making them susceptible to viral and bacterial infections, especially if they are around other children frequently or in daycare.
  • Their adenoids are larger than adults'. Adenoids are located in the back of the nose near the opening of the eustachian tubes and can block the tubes if they become swollen or inflamed.

Having respiratory allergies and a family history of ear infections increases the risk.


Ear tube placement surgery is the most common elective surgery in children in the United States. Ear tubes are tiny cylinders placed through the eardrum (tympanic membrane) to allow air into the middle ear. They are called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes. The tubes can be made of plastic, metal, or Teflon, and may have a coating intended to reduce possible infection.

There are no cut-and-dry rules for when tube placement surgery is indicated. Many experts consider tubes for a child who has had three ear infections in six months or four ear infections in 12 months. Others decide to place tubes when infections are frequent and close together, particularly painful ear infections, or when an ear infection does not clear after a period of time with appropriate antibiotics.

Tubes are also recommended when a child has fluid in their ears (otitis with effusion) for more than three months and/or temporary hearing loss.


By far the most important benefit of ear tubes is that they improve the quality of life for many children, especially in cases where hearing is affected. Hearing problems can have a negative effect on learning and behavior.


Ear tube surgery usually lasts half an hour or less. Your child will be sedated and should not have much, if any, pain. Complications may occur with any surgical procedure. 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: This occurs in around 10 percent 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: A skin growth behind the eardrum
  • Tympanic membrane perforation
  • Risks of general anesthesia

Although some children have complications after getting ear tubes, they are rarely serious. Numerous studies have shown improved quality of life outcomes for children after getting tubes.

Prevention of Ear Infections

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

A Word From Verywell

If you think your child has had too many ear infections, ask your pediatrician for a referral to a pediatric ENT specialist to discuss if ear tubes would be appropriate. A pediatric ENT doctor can also provide a second opinion if you think your pediatrician is recommending tubes unnecessarily.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Conrad, D., Levi., Theroux, Z., Inverso, Y., and U. Shah. Risk factors associated with postoperative typanostomy tube obstruction. JAMA Otolarygology Head and Neck Surgery. 2014. 140(8):727-30. doi:10.1001/jamaoto.2014.1176.

  • Grindler, D., Blank, S., Schulz, K., Witsell, D., and J. Lieu. Impact of Otitis Media Severity on Children’s Quality of Life. Otolaryngology – Head and Neck Surgery. 2014. 151(2):333-340. doi: 10.1177/0194599814525576

  • Rettig, E., and . Tunkel. Contemporary concepts in management of acute otitis media in children. Otolaryngology Clinics of North America. 2014. 47(5):651-72. doi:10.1016/j.otc.2014.06.006

  • 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. doi: 10.1177/0194599815623467

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.