If your child has suffered from several ear infections in a short period of time, you may have heard that they could need tubes. Tympanostomy tubes, commonly known as “tubes”, are tiny bobbin-shaped tubes that are surgically inserted into a child’s eardrum for the purpose of draining off fluid and allowing air to enter behind the eardrum.

Why Do Tubes Work?
Ear tubes are effective at preventing chronic ear infections because of their ability to allow fluid to drain from behind the eardrum. Fluid can easily build up during an upper respiratory tract infection or other illness. The warm, wet environment created by this fluid provides the perfect place for bacteria and viruses to grow, leading to ear infections. Tubes allow the fluid where infection breeds to drain and allows air to pass through the ear canal.

Children are more likely to retain fluid and develop ear infections because a child’s eustachian tube is not as steeply angled or elongated as an adult’s eustachian tube, which causes nasal secretions to back up into the middle ear space. You can tell if the fluid behind the eardrum becomes infected (pus) as your child may run a high fever, not sleep or eat well and can be irritable due to pain when the eardrum bulges. The most common treatment option for an ear infection is an antibiotic.

When Are Tubes Necessary?
When a child develops frequent or recurring ear infections requiring multiple courses of antibiotics within a relatively short span of time (months), or a persistent ear infection that is not responding to antibiotics, your pediatrician may refer you to an ENT for the evaluation of tube placement.

ENTs follow guidelines for when to recommend tubes. If persistent middle ear fluid has been present for several weeks, a hearing test may be done to determine whether the fluid is adversely affecting a child’s hearing.
This is important in school-aged children because it can affect their school performance. It’s also a concern for preschool children as they are developing speech and language skills. If ear infections are not adversely affecting your child’s hearing or overall development, watchful waiting may be appropriate.

If their hearing is impaired, or they have other sensory, physical, cognitive or behavior factors as their baseline (such as Down syndrome, autism spectrum disorder, cleft palate, etc.), ENTs may recommend the placement of Tympanostomy tubes.

How Can Tubes Help My Child?
There are lots of reasons the placement of Tympanostomy tubes can be beneficial for your child. Hearing typically improves after the placement of tubes as sound waves pass through the air but not through fluid. Allowing fluid to drain from the ear allows sound to carry. In turn, speech and language skills are no longer impaired due to hearing deficits. Your child’s temperament may also improve after the placement of tubes. Tubes can improve sleeping, eating and overall comfort level.
There are some considerations after the placement of Tympanostomy tubes. With tubes in place, there is a direct connection between the “outside world” and the “inside world” of the middle ear, so your child should wear earplugs when swimming to prevent organisms from entering the middle ear cavity.

Tubes generally fall out in one to two years, but there is a very small chance that the hole may not heal once the tube falls out, which could require an additional surgery to repair the eardrum. This risk becomes higher with repeated sets of tubes.

If you think your child may benefit from tubes, you can speak to your pediatrician or discuss your options with a pediatric ENT.