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10 Questions Every Parent Asks Before Their Kid Gets Ear Tubes

An ENT offers answers about this common treatment for chronic ear infections.

Toddler wearing floaties stands at the edge of a pool

An ear infection is the most common reason parents take their kids to the doctor. Whether it’s a fever, fussiness or unsoothable cries, it’s frustrating for parents and painful for kids. It’s even worse watching your child suffer from ear infections again and again.

Fortunately, there’s an easy fix: ear tubes. Danielle Liudahl, MD, an ear, nose and throat physician at The Iowa Clinic in West Des Moines answers the most common questions about this simple surgery and how it helps kids.

How many ear infections before my child needs tubes?

After the first ear infection, there’s relief. Your kid is back to their old self. But after the second ear infection, you start to wonder: How many more will they get? Do they need tubes?

Ear tubes are most commonly used to treat recurrent ear infections. Current guidelines state that children with three bouts of otitis media (medical-speak for the common ear infection) in six months or four ear infections in a year are candidates for ear tube surgery, Dr. Liudahl says.

“That’s a starting point, but it’s not a cookbook. If the infections are especially hard to treat or there’s some other factor that complicates it, we may not need that many,” she adds. “Recurrent ear infections, chronic fluid stuck behind the eardrum and hearing loss are all things we’re looking at.”

At what age do kids get ear tubes?

There’s no upper age limit — even adults may need ear tubes! But most children tend to outgrow ear infections around their 5th birthday. So if you’re hovering around that magic number, it’s within reason to wait and see if the ear problems go away as your child grows.

For ear infections in babies, your doctor will recommend waiting until they’re six months old.

“It’s not very typical for a baby under six months to have so many ear infections. Around six months of age is when we’re willing to use general anesthesia and surgery,” Dr. Liudahl says.

Dr. Danielle Liudahl

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How do ear tubes actually work?

The function of an ear tube is simple — it creates an opening that allows excess fluid or infection to drain out from the middle ear into the ear canal.

“They’re seated in the eardrum to restore normal function to the ear. There should be air in there instead of fluid or infection,” Dr. Liudahl explains. “The tube allows for a small opening that relieves pressure, helps ventilate the ear and helps restore hearing.”

What is ear tube surgery like?

The thought of your child going under the knife is scary. But ear tube surgery is one of the most common and quickest surgical procedures there is. In a matter of minutes:

  • Your child gets anesthesia through a mask until they are calm, still and not feeling any pain.
  • A small incision opens the eardrum using a special blade and a microscope.
  • A tiny tube is placed in the opening.
  • Ear drops are put in.
  • The process is repeated for the other ear.

“Overall, the procedure is quick and easy. They won’t even feel the tubes in there!” Dr. Liudahl says. “The kids are normally back to themselves the following day and they feel better. But they can take Tylenol or ibuprofen if needed.”

How long do ear tubes stay in?

On average, an ear tube stays in for a year. But every kid is different. The length of time a child has a set of tubes depends on how their body responds.

“We let the body slowly heal that eardrum and naturally push that tube out into the ear canal. It’s a gradual process, and that process can vary with the child,” Dr. Liudahl says. “What’s neat about that is that the eardrum is healing itself while simultaneously pushing the tube out.”

What happens if a tube falls out?

Don’t be alarmed when an ear tube comes out on its own. That’s what is supposed to happen.

“The crummy thing would be if your child still needs it. If a tube gets pushed out early and your child still needs them, then we may advise putting one back in,” Dr Liudahl says.

A second set of tubes is more common than you think. Even children who have tubes for a full year may need another set if their ear issues haven’t resolved.

“It’s hard because you can’t see the tubes from the outside. Typical follow-up is a month after surgery and then every six months to see how they’re doing and if they’re having more infections or a lot of fluid,” Dr. Liudahl says. “There are things we can see along the way to know if your child has outgrown these issues or if they’ll need to do it again.”

Are there any restrictions or things I need to do after the tubes are in?

There’s little to worry about once ear tubes are in place. There are no restrictions on diet or activity. A lot of parents worry about children getting water in their ears, but kids can still swim and get their heads wet.

According to Dr. Liudahl, there’s no need for ear plugs in the bath tub or pool. But if your child is in a lake, ocean, river or pond, they should wear earplugs. This will keep dirty water out of their ear and help prevent new infections.

“Other than that, there’s no special care required,” she says. “If there are no ear infections or symptoms, there’s no maintenance. Just watch to make sure at some point the tubes come out. It’s really easy.”

Can an ear tube get clogged? How do I unplug it?

One of the best things about ear tubes — their tiny size — can have a bit of a drawback. The opening is so small that it doesn’t take a big chunk of wax or debris to land just right and clog it.

“They’re really tiny tubes, which is great. That means there’s a small hole in the ear drum that easily heals,” Dr. Liudahl says. “The con is that it can plug up or crust up. And when it’s plugged, it’s not able to work and can be annoying.”

Since a plugged ear tube is unable to drain fluid or infection, the pre-tubes symptoms and discomfort may return. Your Ear, Nose and Throat physician can unclog it. If they find the tube no longer works, they can insert a new one.

Will ear tubes affect my child’s hearing?

Tubes do affect hearing. But in a good way! Chronic otitis media and fluid buildup can lead to muffled hearing and even hearing loss. That can impact your child’s speech and development.

It’s standard practice to have a hearing screening by an audiologist before ear tubes are put in. Most times, it’s done the same day — a quick hearing check before ear tube surgery.

“A lot of parents are surprised to learn that ear infections can cause hearing loss. But it’s harder for them to tell, especially for young kids,” Dr. Liudahl explains. “We do a quick hearing test to get a baseline. And about a month after surgery, we make sure the hearing’s okay.”

Does my child need a referral to get tubes put in?

You don’t need a referral for it, but a lot of parents are referred by their pediatrician because it’s something they’ve been watching, Dr. Liudahl says. And if you’re already thinking about it after that third or fourth ear infection, you can explore your options and meet with an ENT.

“It’s one surgery where parents are like, ‘How soon can we do it?’ And that’s what we want to do — help them,” Dr. Liudahl says. “We want to get kids in sooner to help them feel better. We enjoy it.”

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