How Do I Know if My Child Needs Bilateral Ear Tubes?

What are bilateral ear tubes?

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 “PE tube" or “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 and how 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. This warm, wet environment created by the fluid provides the perfect place for bacteria and viruses to grow, leading to ear infections. 

Tubes allow the fluid to drain and allows air to pass into the middle ear (the space behind the ear drum) to heal the tissue behind the ear drum. The tissue behind the ear drum was meant to breathe, but when fluid has been sitting behind the ear drum for weeks or even months, the tissue behind the ear drum becomes inflamed.

Children are more likely to retain fluid and develop ear infections, because a child’s eustachian tube (a thin tube that connects the middle ear to the top of the throat) is not as steeply angled or stretched out as an adult’s eustachian tube. This causes nasal secretions to back up into the middle ear space. You can tell if the fluid behind the eardrum becomes infected, because your child may run a high fever, not sleep or eat well, and can be excessively irritable due to pain and even have pus drain from the ear. 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 short span of time, or a persistent ear infection that is not responding to continued antibiotics, your pediatrician may refer you to an ENT for the evaluation of tube placement.

Ear, nose and throat (ENT) doctors follow guidelines for when to recommend tubes. If consistent middle ear fluid has been seen for several weeks, a hearing test may be done to determine whether the fluid is affecting a child’s hearing. This is important in school-aged children because it can affect their school performance. But it’s also a concern for toddlers as they are developing speech and language skills, which they learn by mimicking what they hear. If ear infections are not negatively affecting your child’s hearing or overall development, it may be okay to wait and see if their issues get better over time.

If their hearing is affected, or they have other sensory, physical, cognitive or behavior factors or diagnoses, such as Down syndrome, autism spectrum disorder, cleft palate, etc., your ENT may recommend the placement of Tympanostomy tubes.

How can tubes help my child?

There are many reasons that placement of Tympanostomy tubes can help your child. Hearing typically improves after the placement of tubes, because sound waves are able to pass through the air easier than they pass through fluid. Allowing fluid to drain from the ear helps sound be carried through. In turn, speech and language skills no longer suffer because of hearing loss. Your child’s overall mood and behavior may also improve after the placement of tubes. Tubes often improve sleeping, eating, balance and overall comfort.

There are some things to take into consideration after the placement of Tympanostomy tubes. With tubes in place, there is a tiny window between the outside world and the middle ear, so your child may need to wear earplugs at times, especially while swimming or splashing around in lakes or rivers, to prevent organisms from entering into the middle ear cavity.

Tubes generally fall out in one to two years, but there is a small chance that the hole may not heal once the tube falls out. This could require an additional surgery to repair the eardrum. This risk of the hole not closing on its own 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.