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Recurrent Ear Infections After Tubes

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You Should Call The Doctor If:

Ear Tubes for Small Children with Recurring Ear Infections | Cedars-Sinai
  • Your child cannot keep any fluids down or keeps vomiting
  • Develops a fever
  • Has new ear pain or pain that does not go away with medicine
  • The prescribed ear drops cause discomfort
  • One or both of your childs ears drain for more than 7 days after surgery
  • Your child has yellowish-green ear drainage, or has a bad smell coming from his/her ear
  • Ear tube falls out in the first few weeks

See the doctor right away or go to the emergency room if there is a lot of blood in the ear drainage or if the ear pain is severe.

Before Ear Tube Surgery

Little preparation is needed before ear tube surgery. In some cases, youll just need to show up at the required time. But if your doctor is using a general anesthetic for the procedure, you or your child will need to fast before the procedure. Your doctor will provide specific instructions based on your childs age and diet.

Are you awake during ear tube surgery?

It depends. The type of anesthesia thats used for ear tube surgery is determined by your age and type of ear tubes that you need.

For adults, a topical anesthesia is typically used, so you would not be able to feel any pain and would be awake for the procedure.

For kids, they are usually given general anesthesia so they can sleep during the surgery. Talk to your doctor to see what options are available for you or your child.

What Are Ear Tubes

If your child has frequent ear infections and tends to retain fluid in the middle ear between infections, has chronic fluid build-up in the middle ear, or has hearing or speech problems related to fluid and infections in the ears, your childs doctor may recommend ear tubes.

Ear tubes are tiny cylinders, usually made of plastic and sometimes metal, that are surgically inserted into your childs eardrum. These tubes allow air to flow in and out of the middle ear, which prevents the development of negative pressure as well as fluid build-up. Ear tubes may also be called tympanostomy tubes, myringotomy tubes or ventilation tubes.

Ear tube surgery, also known as tympanostomy tube insertion surgery, is the most common childhood surgery performed in the United States. Surgeons in the Division of Otolaryngology at CHOP surgically implant ear tubes in more than 4,000 children each year.

The ear tube insertion surgery is performed under general anesthesia and takes on average eight to 15 minutes. After a brief recovery in a post-operative unit, most children will be sent home the day of surgery.

The average age for ear tube insertion is 1 to 3 years, but babies can get ear tubes as young as 6 months.

Ear tubes are generally extruded from the ear drum anywhere from six to 18 months after insertion. If the tubes fall out and your child still has frequent ear infections, continues to accumulate fluid, or his eardrum collapses again, he may need to have the tubes reinserted.

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What Causes A Middle

The middle ear connects to the throat by a canal called the eustachiantube. This tube helps even out the pressure between the outer ear and theinner ear. A cold or allergy can irritate the tube or cause the area aroundit to swell. This can keep fluid from draining from the middle ear. Thefluid builds up behind the eardrum. Bacteria and viruses can grow in thisfluid. The bacteria and viruses cause the middle-ear infection.

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When Does A Child Need Ear Tubes

Middle Ear Effusion

Your childs doctor may recommend ear tubes if one or more of the following conditions are present:

  • Fluid in the ears for more than three or four months following an ear infection
  • Fluid in the ears and more than three months of hearing loss
  • Changes in the actual structure of the eardrum from ear infections
  • A delay in speaking
  • Repeated ear infections antibiotics over several months

Ear tubes allow time for the child to mature and for the Eustachian tube to work more efficiently. By the age of 5 years, the Eustachian tube becomes wider and longer, allowing for better drainage of fluids from the ears. The tubes usually fall out on their own after six to twelve months. After they fall out, if ear infections recur, they may require replacement.

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Ear Infections And Ear Tubes

Provided by Michael J. Loochtan, MD

Ear infections are one of the most common disorders to that affect children. These can often be managed with medication without the need for further intervention. Sometimes, however, your childs doctor may recommend that your child have an evaluation with an otolaryngologist. Below is an explanation of what ENTs are, a discussion of normal ear anatomy, and an explanation of when ear infections may warrant consideration for ear tube placement.

WHAT IS AN OTOLARYNGOLOGIST ?An ENT is a doctor who is specially trained to diagnose and treat disorders of the ears, nose, and throat medically or surgically if needed. Therefore, they are also called head & neck surgeons. Its a mouthful to say Otolaryngologist Head & Neck Surgeon therefore usually we just go by ENT. ENT training is quite rigorous and entails 4 years of medical school after college, followed by 5 years of residency training. Some ENTs pursue additional specialized training after residency. This extra training is called a fellowship and is usually 1-2 years in length.

WHAT ARE THE PARTS OF THE EAR?Please see the diagram below.

Rosenfeld RM. A Parents Guide to Ear Tubes. Hamilton, Ontario, Canada: BC Decker 2005. Reproduced with permission.

Below is some very helpful information from the American Academy Of Otolaryngology Head and Neck Surgery regarding ear tubes . More information can be found at

Chronic Inflammation In The Middle Ear

If the middle ear is always inflamed, it can lead to hearing loss, delayed development, a tear in the eardrum and chronic discharge. If you or your child has ongoing middle ear inflammation, your doctor may recommend ear tube surgery to prevent new infections, or ear endoscopy surgery to repair the eardrum.

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What If The Tube Comes Out Too Soon

Once we place the tube in the ear, we dont have any direct control over its exact placement or how long your body allows it to remain in the ear. In some cases, it may come out too soon. For other patients, it may stay in too long. When the tube doesnt naturally come out after several years, we may consider pulling it out. Although rare, these situations can result in a small or large hole in the eardrum that may need to be repaired.

The most common complication, however, is that the tube clogs. A little dried blood or mucus may not allow the tube to drain properly, but its easily fixable in the clinic.

What Are Tubes And Why Might I Need Them

Ear Infections & Ear Tubes

In some adults, eustachian tube dysfunction doesnt allow the ear to operate correctly. For some patients, allergies or infection causes blockage in the nose due to inflammation. In other patients, the tube developed to be too narrow. Whatever the reason, the ear isnt working as it should.

Ear tube placement allows the ear another way to equalize pressure. The tube, which looks like a small grommet, is made of soft rubber in order to be minimally traumatic to the eardrum. Once inserted, it vents the ear, acting as a pressure valve to compensate for the lack of function from the eustachian tube. It works to drain fluid, relieve negative pressure, and sometimes alleviate a feeling of fullness in the ear as well.

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When To Consider Tubes In Ears

Otitis media, more commonly called an ear infection, is an inflammation of the middle ear, the space behind the eardrum. It can be caused by either a virus or bacteria and results in fluid build-up in the middle ear. Ear pain and fever are the most common symptoms. Ear drainage, or fluid that leaks from the ear, can also occur if the eardrum ruptures. Children are affected more frequently than adults, and about 5 of every 6 children will have experienced at least one infection by their first birthday.

Ear infections are usually treated with pain medication for the discomfort and with antibiotics if there is a suspected bacterial cause. However, sometimes ear infections dont successfully go away with oral antibiotic and become more severe or come back repeatedly.

If your child has frequent or recurrent ear infections, persistent fluid build-up in the middle ear that results in hearing loss, imbalance and/or discomfort or struggles with side effects from repeated oral antibiotic use, your doctor may suggest ear tubes and refer you to an otolaryngologist, or an ear, nose and throat surgeon.

In these instances, surgery may be necessary. Surgery for middle ear infections often means placing a drainage tube into the eardrum of one or both ears. It is the most common operation performed in childhood.

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Benefits And Risks Of Ear Tubes

Frequent ear infections can lead to decreased hearing, speech and balance problems and changes to the childs ear drum. The benefits and risks of ear tube insertion, however, are different for each child. It is important to discuss all of the benefits and risks with your child’s healthcare provider and jointly decide what is best for your child.

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When Should You Worry About Ear Drainage

A common concern parents have is around blood or other drainage coming from their childs ears in the days following ear tube surgery. You may worry that theres a problem with the tubes. But the drainage is actually a sign that the tubes are doing their job.

Early ear drainage like this is usually not a cause for concern, says pediatric otolaryngologist Brandon Hopkins, MD. In the weeks and months after your child gets ear tubes, drainage is a sign of an ear infection and is often easily treated with topical antibiotics.

Is ear drainage ever a problem, though? Only if its chronic, which means its been happening for more than a month, even with antibiotic drops, Dr. Hopkins says.

If your childs ear drainage becomes chronic, its important to follow up with the surgeon. They may recommend additional treatment. This may include ear suctioning, topical antibiotics or powders, or an oral antibiotic, he says.

Why Consider Ear Tubes

7 Undesirable Ear Tube Complications (which may require more surgery ...

Reasons a child or adult may need ear tubes include the following:

  • Frequent middle ear infection. Beneath the eardrum, there is an open area that is home to tiny vibrating ear bones. When a bacterial or viral infection settles in there, the result is sudden inflammation and pain.

  • Hearing loss related to middle ear fluid. Frequent middle ear infections, allergies and other conditions can cause fluid to form and stay in the middle ear for a prolonged period. Eventually, this fluid can result in hearing loss.

  • Dizziness related to middle ear fluid. Fluid in the ear can cause dizziness and is a readily treatable cause of dizziness. In young children, this dizziness may appear as lack of coordination.

  • Tinnitus related to middle ear fluid. Fluid in the ear can cause tinnitus, or extra sounds in the ears. This can sound like your pulse, or like ringing or a seashell. This is a treatable cause of tinnitus.

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Can You Still Get Ear Infections With Ear Tubes

Though it doesnt happen often, its possible to get an ear infection with ear tubes. But if you or your child gets an ear infection after the surgery, it probably wont be as bad. Ear tubes allow the fluid, and infection, to drain from the ear, so youre less likely to have ear pain and hearing loss.

Otitis Media In Adults

Otitis media is another name for a middle ear infection. It means an infection behind your eardrum. This kind of ear infection can happen after any condition that keeps fluid from draining from the middle ear. These conditions include allergies, a cold, a sore throat, or a respiratory infection.

Middle ear infections are common in children, but they can also happen in adults. An ear infection in an adult may mean a more serious problem than in a child. So you may need additional tests. If you have an ear infection, you should see your healthcare provider for treatment. If they happen repeatedly, you should see an otolaryngologist or an otologist .

What are the types of middle ear infections?

Infections can affect the middle ear in several ways. They are:

Who is more likely to get a middle ear infection?

You are more likely to get an ear infection if you:

  • Smoke or are around someone who smokes
  • Have seasonal or year-round allergy symptoms
  • Have a cold or other upper respiratory infection

What causes a middle ear infection?

The middle ear connects to the throat by a canal called the eustachian tube. This tube helps even out the pressure between the outer ear and the inner ear. A cold or allergy can irritate the tube or cause the area around it to swell. This can keep fluid from draining from the middle ear. The fluid builds up behind the eardrum. Bacteria and viruses can grow in this fluid. The bacteria and viruses cause the middle ear infection.

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What To Expect From Ear Tube Surgery

If your child is in need of ear tubes, you probably know why: lots of ear infections. And if your family is facing a decision about ear tube surgery, youre not alone. After the common cold, ear infections are the most common reason that young children visit their pediatricians.

In many cases, ear infections clear up on their own without antibiotics or surgery. But repeat infections, known as recurrent otitis media can be problematic and be persistent causing pain or hearing problems due to the inflammation and fluid buildup behind the eardrum. As a pediatric ear, nose and throat specialist, I often recommend surgery to insert an ear tube for children who experience severe, recurrent ear infections.

Placing tubes in the ears has many benefits. An ear tube drains the fluid and equalizes the pressure in the middle ear. Ear tubes provide access to the infected area of the ear, allowing the use of eardrops to treat the ear infection. Ear drops are a safe alternative to the use of oral antibiotics, which can have side effects. If a child experiences hearing loss because of fluid or repeat otitis media, ear tubes can often restore hearing.

What to Expect From Ear Tube Surgery

Ear tubes can be inserted in an outpatient surgery clinic, which means your child doesnt need to be admitted to the hospital overnight. Even if your child needs tubes for both ears, the surgery takes 10-15 minutes.

What’s Best For Recurrent Ear Infections In Kids

Ear tubes could be the answer to your child’s ear infections.

HealthDay Reporter

THURSDAY, May 13, 2021 — Frequent middle-ear infections are the nemesis of many parents and young children. Now a new study suggests that a common treatment — “ear tubes” — may not prevent future bouts.

Middle-ear infections are second only to the common cold in creating childhood misery. They occur when the air-filled space behind the eardrum becomes infected and fills with fluid — which can cause pain, fever and obstructed hearing.

Some babies and young children are prone to frequent infections. One treatment option is to surgically place a tiny tube in the eardrum, to help drain fluid built up behind it.

But the new study, published May 13 in the New England Journal of Medicine, found that the tactic did not thwart future infections.

Among 250 babies and toddlers researchers followed, those treated with ear tubes suffered about as many middle-ear infections over the next two years as those who received only antibiotics for each bout.

The good news is that infections in both groups dissipated over time, said lead researcher Dr. Alejandro Hoberman of UPMC Children’s Hospital of Pittsburgh.

Kids normally outgrow the infections, he explained. Babies and toddlers are prone to them because of the structure of their eustachian tubes, which help drain fluid from the middle ear. As little ones grow older, that changes.

According to Hoberman, the new findings suggest that for many children, tubes can be avoided.

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Prepare For Your Myringotomy

  • Arrange for a ride to and from the procedure.
  • Do not eat or drink anything for at least eight hours before the procedure.

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:

  • Nonsteroidal anti-inflammatory medications

Alternatives To Ear Tubes

You may be wondering, can ears drain without tubes? Are there other treatments that work?

While there are many ways to treat ear infection symptoms, youre likely looking into ear tubes because you or your child has chronic or recurring middle ear problems that havent been helped by antibiotics or other at-home treatments. If other treatments arent working, ear tubes are generally recommended as a next step. But here are a couple of other possibilities:

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Ear Drops For Ear Tubes

Ear drops are often prescribed after surgery. Begin using these drops on the evening of surgery, as directed by your doctor. Prior to using drops, warm the bottle by either carrying it in your pocket or holding in your hand for a few minutes. After instilling the drops, massage the front of the ear next to the opening of the ear canal several times. This helps to propel the drops into the ear canal and through the tube. Your doctor may recommend additional use of drops if there is drainage for more than 72 hours after surgery since persistent drainage is a sign of ongoing infection. If the drainage continues for more than seven days, or if other symptoms arise, please call our office.

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