Ear tubes are small tubes inserted into the eardrum to help drain fluid and equalize pressure in the middle ear. These tubes may be recommended for children and adults experiencing specific ear-related issues. 

Here, we provide an overview of the reasons for recommending ear tubes, the procedure involved, potential risks and follow-up care.

Reasons for recommending ear tubes

Ear tubes are most commonly placed in children for recurrent ear infections or persistent fluid in the ears. They can also be recommended for hearing loss associated with learning disabilities when there is a history of persistent middle ear fluid or infections. 

The most common reason for tube placements in adults is a sensation of ear fullness or pressure in the ears, says neurotologist Geoffrey Casazza, MD. He explains that the culprit is thought to be a dysfunction of the eustachian tube, which connects the middle ear to the back of the throat.

“For pressure issues, the ear tube works by bypassing the eustachian tube,” he says. “It provides a pressure release valve.”

Ear tubes in adults can also help with repeated ear infections, persistent fluid or ear pressure problems when flying.

The procedure

The surgical procedure known as tympanostomy, or ear tube placement, varies based on age and circumstances.

For children:

• The procedure is typically performed in an operating room under general anesthesia.
• A small incision is made in the eardrum, and the tube is inserted to allow fluid to drain and equalize pressure.

For adults:

• Most procedures are done in a clinic setting with local anesthesia.
• The eardrum is numbed, a small incision is made and the tube is inserted.
• In cases where the procedure is too uncomfortable or there are anatomical challenges, it may be performed in an operating room.

How ear tubes help

Ear tubes can effectively address ear problems and alleviate symptoms. They help in the following ways:

• Pressure relief: By bypassing the eustachian tube, ear tubes act as a pressure release valve, helping to equalize pressure in the middle ear.
• Fluid drainage: Tubes provide an outlet for fluid to drain, reducing the risk of infections and improving hearing.

Ear tubes typically stay in place for about a year and eventually fall out on their own. Some may fall out sooner, while others may stay longer and need to be removed by a doctor.

For children, the need for tubes often diminishes as they outgrow the problem. However, if there are ongoing problems, they can be replaced after they fall out. Adults with persistent issues may require alternative treatments.

“If we’ve had to place lots of tubes in an adult patient, sometimes we’ll switch and do an eustachian tube dilation in the operating room,” Dr. Casazza says. “Essentially, we’re trying to bypass the eustachian tube or correct the underlying problem.”

Complications and follow-up care

Ear tubes create a hole in the eardrum. The hole may heal on its own or it may stay open without causing any issues. Problems occur when the hole leads to symptoms like discomfort or hearing loss.

“Sometimes, the patients need the hole, and it is actually beneficial on its own,” Dr. Casazza says. “If they are bothered by the hole, or it’s causing noticeable hearing loss, we can fix the perforation.”

After ear tube placement, regular follow-up visits are scheduled to monitor the tubes' status. Earplugs are recommended for swimming in lakes, rivers or oceans. In general, bathing or showering is not a concern, but patients experiencing pain or drainage should take precautions. 

Additional considerations

Ear infections are often overdiagnosed, especially in children. It is important to differentiate between actual infections and other causes of ear pain or pressure. An ear, nose and throat, or ENT, specialist can provide an accurate diagnosis and appropriate treatment.

Since ear problems can cause hearing loss, which can impact speech and learning, it is essential that children with difficulties are identified and supported, Dr. Casazza says.

“If you don’t realize the child has fluid or a hearing loss, they will fall behind,” he says. “If you know, appropriate accommodations can be made, or we can try to correct the hearing loss, and those kids will do fine. But it’s the kids we don’t know about that are the bigger issue.”

Many ear problems in adults can be managed with options such as using saline nasal rinse, applying nasal steroid spray or taking allergy medication. For those experiencing feelings of ear fullness, conditions such as temporomandibular joint, or TMJ, should be excluded before proceeding with ear tube insertion.