Ear tube surgery: What to know

Share on Pinterest

Ear tube surgery is surgery to place a tube in one or both ears.

Otitis media with effusion (OME), a type of middle ear infection where fluid accumulates behind the eardrum, can cause intense pain and fluid loss. These infections are more common in people with eustachian tube dysfunction.

Ear tube surgery places a tympanostomy tube into the eardrum, which helps the middle ear drain. This surgery can prevent ear infections and hearing loss. Over time, while the eardrum heals, the tubes fall out on their own.

In most cases, ear tube surgery is for people with chronic ear infections, chronic fluid behind the eardrum, or both. In children, hearing loss from fluid or speech delay with fluid are indications for surgery.

Unilateral refers to an infection in one ear, whereas bilateral refers to an infection in both ears.

The American Academy of Otolaryngology-Head and Neck Surgery recommends surgery for people who meet any of the following criteria:

• bilateral chronic ear infections for 3 months or longer, along with fluid behind the ears and hearing loss
• bilateral or unilateral ear infections with fluid behind the ears, for 3 months or longer, along with:
  • behavioral problems
  • balance issues
  • poor school performance
  • other serious quality-of-life issues related to ear infections
• three or more episodes of ear infection with fluid buildup in 6 months, or 4 infections in 12 months that required antibiotics
• ear infections with fluid buildup in at-risk children, including those with the following conditions:
  • permanent hearing loss
  • developmental disorders
  • speech or language delays
  • blindness
  • other developmental disabilities

While OME and recurring ear infections occur more commonly in children, they can affect adolescents and adults, warranting the need for ear tube surgery in this population.

Insurance typically covers ear tube surgery if the surgery meets the insurer’s guidelines. People should review their insurer’s policy documents or call to get pre-approval.

Clinics performing the procedure generally cite prices ranging from $3,000 to $7,000. A hospital operating room typically increases this price because of the additional equipment and personnel needed. The overall price does depend on many factors, such as geographical location.

People with insurance, however, do not typically pay the full price. They either pay a copay or a deductible.

The main risks of surgery include the following:

• complications from anesthesia, which may range from short-term issues like nausea to more severe problems such as breathing difficulties during surgery
• damage to structures in the ear, especially the eardrum
• problems with the tubes, such as blockages or tubes that move to the wrong location in the ear
• excessive bleeding during or after surgery
• infection

Additionally, surgery does not always work to reduce ear infections. This means it is important to weigh the benefits against potential risks, especially for people with a history of only minor ear infections.

It is not the only way to treat ear infections. Other methods include ear drops and antibiotics. Otic drips can be beneficial if the person with the infection has no fever.

The procedure of inserting ear tubes is safe. In the United States, it is a commonly performed surgery in children between the ages of 1 and 3.

Typically, ear tube surgery can have the following benefits:

• reducing the risk of infections in future
• restoring hearing loss
• improving speech and balance issues the child may be experiencing
• improving certain behavioral issues or sleeping issues
• improving a child’s performance in school

Prior to surgery, a doctor refers a person to an otolaryngologist — known also as an ear, nose, and throat specialist. The otolaryngologist will:

• examine the ears
• ask about a history of ear infections
• discuss the risks and benefits of surgery

Whether or not to have surgery is ultimately the patient’s choice, or if it involves a child, then their caregivers’ choice.

Depending on the time of the surgery, children may or may not need to fast the night before.

Typically, the surgery — usually lasting around 15 minutes or less — involves the following steps:

• The appropriate anesthesia is given to the person before surgery commences.
• Then, the surgeon makes an incision on the ear drum and drains out the fluid in the middle ear space.
• Finally, a tube, either metal or plastic, is placed in the opening of the hole, and the surgeon may also administer ear drops.

The type of anesthesia administered may depend on whether a child or adult is undergoing the procedure:

Toddlers and younger children

Babies and young children receive full sedation for the surgery. This means that they are asleep under general anesthesia in an operating room. Depending on the hospital, a child might go to the operating room with their parents, then receive anesthesia — via a mask— to go to sleep. Or they might go to the operating room alone.

In either case, the child will have no memory of the procedure and will feel nothing while it happens.

Adolescents and adults

Adolescents and adults who choose an in-office procedure will first have some topical numbing on the ear drum. Rarely, lidocaine injections are used to numb the area.

A doctor will then insert the tubes while the person is fully numb. They may feel tugging or odd sensations but should not feel any pain.

The surgery usually takes only a few minutes.

The recovery period may vary slightly for children and adults:

Toddlers and younger children

Having general anesthesia means a slightly longer recovery period.

Children may be groggy for a day or 2 after surgery. Some people feel nausea or vomit after general anesthesia. The child may seem confused, become irritable, or cry. Babies and toddlers may want to nurse more than usual.

Children may have pain for a few days. They may need to sleep more. A doctor may prescribe medication for pain or recommend over-the-counter medication. For example, one dose of Tylenol (Motrin) after the operation.

Home treatments such as heating pads and more frequent nursing for babies and young children may also help.

Most children should be able to return to school the following day.

Doctors should be able to advise when children can resume activities such as bathing and swimming, this may be around 2 days.

Adolescents and adults

Having local anesthesia — that does not put the person to sleep — means fewer anesthesia side effects.

Children, adolescents, and adults may have pain for a few days and should use antibiotic ear drops as a doctor prescribes them. Contact a doctor if the pain gets worse, a person loses hearing, or a person has any questions about recovery.

This depends on many factors.

Short-term tubes may fall out on their own after 6 months to 2 years. However, long-term tubes stay in place for an extended amount of time before naturally falling out. Sometimes, these tubes may require surgical removal.

Some of the most common complications of ear tube surgery include:

• fluid draining from the ears
• a blockage in the tympanostomy tube
• scar tissue
• tubes that prematurely fall out
• damage to or perforation of the eardrum
• tubes that do not fall out
• tubes that travel into the middle ear

Follow-up care with a provider can correct these issues. In some cases, a person might need antibiotics.

A surgeon might have to remove the tubes or redo surgery.

Another procedure called adenoidectomy, where tissue located in the throat behind the nose is removed may be beneficial for people with persistent middle ear fluid.

Contact a doctor if:

• A person develops new or worsening pain after surgery.
• A person has a high fever.
• A person is bleeding bright red blood from the ear.
• A person cannot hear after surgery.
• Healing seems to be moving very slowly.
• A person develops symptoms of an ear infection, such as purulent drainage where the wound leaks a milky discharge.

Ear tube surgery may help children and some adults have fewer ear infections. People should discuss treatment goals, risks, and benefits with a healthcare professional before undergoing.

For people who have tried medical management to reduce ear infections, or for those who develop hearing loss or other complications from ear infections, ear tube surgery may help prevent serious complications.