Ear infections represent one of the most common reasons children are seen by physicians. Nearly 75% of children under the age of 7 will have at least one ear infection, but most children outgrow ear infections as their immune systems and eustachian tubes mature. Still, many children continue to have recurrent and chronic ear infections.
My previous blog posts highlight important ear infection facts, ear infection myths, and complications of ear infections.
Ear Nose and Throat (ENT) surgeons place ear tubes which save thousands of children every year from severe ear pain, hearing loss and use of antibiotics. Be sure to check out my podcast about what you should (and should not) expect from ear tubes!
Common ear tube questions and ear tube myths have been discussed in previous posts to allow parents to better understand their potential value. Nevertheless, ear tube complications remain possible.
Parents gain knowledge about the expectations for ear tubes when they speak with their child’s surgeon. Common events which occur while ear tubes are in place are not considered complications. Mucous leaking out of tubes is NOT an ear tube complication. The need for more ear tubes after they successfully fall out is also NOT an ear tube complication.
True ear tube complications typically arise after the tubes have been in place for an extended period of time. All surgeons inform parents that the tubes should fall out; however, the process for following the ear tubes varies.
After I place ear tubes, I personally follow my patients every 6-12 months until the tubes have fallen out. If the tubes remain in place after 2 years, I discuss the need for removal because the risk of these undesirable ear tube complications increases over time.
Some surgeons do not routinely follow patients after ear tubes are placed. These patients are followed by their pediatricians who refer patients back to the ENT physician if a problem arises. Parents should make sure they fully understand the followup plans after ear tubes are placed. I believe it is a good idea to return to the ENT surgeon if tubes have been in place for 2 years, even if no problems have yet occurred.
This blog addresses ear tube complications that frequently require additional surgery. Thus, these are true undesirable complications that result from the insertion of ear tubes.
7 Undesirable Ear Tube Complications
1. Ear tube blockage
During surgery, a small incision is made in the eardrum in order to insert the tube. Ear drops are typically prescribed after surgery to treat any remaining infection behind the eardrum and also to rinse away fresh blood so it does not clot and block the tube.
Many children resist ear drops being inserted into their ears (READ: wildly fight and reject drops for reaching their target!). Parents may then be unsuccessful at putting in drops as directed. When the child is checked after surgery, dried blood or mucous may block the tube. Sometimes the tube can be opened but other times, new tubes need to be placed.
When an ear tube become blocked many months after placement, different treatment options are available. Most of the time, nothing needs to be done as this type of blockage may be part of the process of the tube falling out. When air is noted to be in the middle ear, this means that the eustachian tube has begun to work well; therefore, the tubes simply need to be monitored to be sure they fall out.
If the tube is blocked and there is air in the middle ear, this indicates that the eustachian tube has begun to work well and the tubes simply need to be monitored to be sure they fall out.
If the tube is blocked and there is fluid trapped in the middle ear again, further evaluation is needed. Over time, the eustachian tube should be working better; consequently, fluid in the middle ear suggests a potential chronic nasal problem. Allergies, enlarged adenoid and sinus problems are common problems that need to be addressed to improve the natural drainage of fluid from the middle ear.
2. Ear tube remains in eardrum too long
Tubes are temporary and need to come out of the eardrum. If the tubes do not fall out on their own, they will need to be removed. These are called retained ear tubes.
Depending upon how old the child is and how much of the tube has already started to come out, some tubes can be removed in the office. However, because the tube is still lodged in the eardrum, it may be very painful.
Tubes that do not fall out on their own sometimes require ENT surgeons to remove the tube in the operating room.
3. Chronic infection and irritation around the ear tube
Our immune systems are designed to attack substances that are recognized as foreign. This works well for viruses and bacteria. Tubes and other surgically implanted medical devices are often recognized as foreign objects.
If tubes do not fall out, the body increases the immune system attack, and the tissues around the tube become extremely inflamed. Eventually, swelling and irritation turn into infected granulation tissue. As more time goes by, this tissue matures into a granuloma which can actually grow and completely cover the ear tube.
Antibiotics and ear drops are useful in treating this inflamed tissue but the main treatment option would include removing the ear tube to stop the foreign body reaction.
4. Hole in ear drum (Perforation)
Most ear tubes successfully fall out of the eardrum into the ear canal while the eardrum closes. However, if tubes stay in the eardrum too long, scar tissue may form around it. This scar tissue then allows the ear tube to simply fall out of the eardrum without the slow growth to close the hole. A chronic hole in the eardrum (perforation) can then occur.
If the perforation is small, it may slowly continue to heal and close on its own. But many chronic eardrum perforations require a more extensive surgery to rebuild the eardrum and close the hole with a graft.
5. Ear tube falls out of eardrum into the middle ear
Extrusion is the process of the ear tube being slowly pushed out of the eardrum into the ear canal. In rare cases, the tube falls into the middle ear, and the eardrum heals over the tube. This process is called intrusion.
The tube trapped in the middle ear can stimulate a foreign body reaction and lead to middle ear infections, or fluid collection.
Surgery is required to remove the tube from the middle ear.
6. Eardrum scarring
Any chronic irritation of the eardrum, including recurrent ear infections or ear tubes, can cause eardrum scarring. This scarring occurs when white, hard calcium deposits collect on a normally thin eardrum.
Eardrum scarring is called tympanosclerosis (TIM-pan-O-SKLER-O-sis) or myryngosclerosis (MER-ring-GO-skler-O-sis).
In most cases, the scarring causes no problem with hearing and does not need any treatment; however, the scar tissue can replace a large part of the eardrum or extend into the middle ear space. This more aggressive scarring may cause significant hearing loss and need surgery to correct it.
7. Cholesteatoma (KO-less-TEA-uh-TOE-muh)
You may or may not have noticed, but many ear tube complications can also occur as a complication of recurrent ear infections. One of these severe complications that can occur, even if a child never requires ear tubes, is the dreaded cholesteatoma.
The process for cholesteatoma formation around the ear tube occurs because the tube can trap skin under its edges where it may not be easily seen. The skin from the outer ear can then grow into the middle ear and can cause severe damage to hearing structures or lead to life-threatening infections.
Potential trapped skin that may not be visible; consequently, this represents one of the reasons that ear tubes must be removed if they do not fall out.
The eardrum is not supposed to have a permanent connection from the outer ear to the middle ear. Close monitoring of ear tubes can often prevent these complications.
Make sure your ENT surgeon or pediatrician has clearly told you that the tubes have fallen out of your child’s eardrum to avoid these undesirable ear tube complications.
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I had never heard of a cholesteatoma, until the surgeon came out too quickly from replacing my daughter’s tubes to tell me he had found one. It required a lengthy surgery and removal of bones. We aren’t in the clear yet, but at least we know what we are dealing with.
Oh, I am sorry to hear that but happy your child is on the way to recovery. I have also had to share this news with many families after planning a simple ear tube placement or removal. The good news is that finding it early makes it easier to treat.
So my 11 month olds tubes are blocked and hv been since a couple days post placement is there anything I can do to help unblock them ? Pediatrician suggested that there may be but she wasn’t sure exactly what to use. She has bilateral ear infections constantly, tubes did not help her at all ☹️☹️☹️ Idk what to do anymore
I am so sorry to hear about your child. Blocked tubes right after surgery are really bad since they never had a chance to work. Yes, there are ways to unblock them and I do it every day. But it depends on how long they were blocked, so the sooner they are opened the better.But ongoing infections means something else is wrong. Like nose things! Hopefully, you are washing nose with salt water every day. Feel free to read my posts on saline washes and the benefits of salt water. If doing that every daily is not helpful, you might follow up with ENT to discuss allergies but aggressive saline is very helpful for most of my patients.
Great article! My 18 yo son is heading off to college next week. He likely will not be able to fulfill part of his future dreams to join the military due to a permanent eardrum perforation. He had one surgery to repair this a few years ago, but the graft didn’t take. I’ve been told he has scar tissue on both eardrums after multiple sets of tubes over the years. I wish I would have been presented with this information way back when he got his first set of tubes at 6 mos.
Oh my goodness. This is indeed a rare situation where it cannot be repaired. I might suggest he see an OTOLOGIST. That is an ENT physician who only specializes in ear problems. They have seen a greater number of complications and have more success in repairing perforations that others may not be as successful with. All cities may not have this sub-sub specialist but I would definitely get that opinion! Good luck.
My son got his tube surgery 4 days ago. After one day one of his ears started to have yellow discharge and got infected. His doctor prescribed saline drop and antibiotics for seven days. Although his discharge has been stopped, whenever I put drop into his infected ear he has lots of pain. I am so worried about his ear. Does this pain show that something went wrong during surgery?? Open wound? I wonder why his dr didn’t describe drop immediately after surgery, even now she described drop only for infected ear.
Some people never have mucus leaking from tubes while others have it each time they have a cold or allergy. The treatment is antibiotic drops like your doctor prescribed. The drops are only used in the draining ear. Pain with drops after drainage stops is also common. Not a surgery complication. You should talk to your doctor because it could mean it is time to stop the drops. This cycle could repeat itself many times but it allows your child to avoid taking regular antibiotic!
I am 30. I have always had bad allergies and asthma. Few years ago my ears keep becoming infected more than usual. My ears would hurt badly. When I went was said lots of fluid making eardrum bulging out. But was clear so no infection. Then two or so days later back in doctor because it then turned into a infection. Last year I got a tube in one ear then it had to be redone and then both ears had them. They seem to help but my ears always itch alot! I have had lots of ringing in my ears and somedays if I could rip everything out and not feel anything in my ears I’d be a happy woman!! Any thoughts
A great article. My son just had both ventilation tubes removed after two years and the holes in the ear drums are so big but given ear drops, the ent specialist assured us that theyll heal by themselves..Am worried please help.
My 10 year old in about to have his 4th tube placed next Friday. No major allergies. Usually a long fall/winter cold, which we use saline rinse to avoid ear infections. Haven’t had an ear infection for 2-3 years. But, still have middle ear fluid & a retracted drum after the 3rd tube naturally grew out. So, what are your thoughts on focusing attention on the eustasion tube that’s not draining the fluid in the first place? I’d prefer to fix the cause & avoid more scarring. My ENT didn’t present this as an option & in my research I read about stints or a balloon surgery to fix the eustasion tube. That technology too new to trust? Thanks for your thoughts Dr. B. – Momma! Sincerely, MaMa Bird
So sorry to hear about your child. But there really is no such thing as a long cold! A cold is a viral infection that lasts about 2 weeks. Many people with long colds actually do have allergies! Saline is awesome but does not address the nasal inflammation which blocks the Eustachian tube. Make sure you have had formal allergy skin testing, had adenoid removed, ruled out silent gastric reflux and have used nasal steroids to reduce inflammation. Ear tube surgery is meant to be temporary. The balloon dilation of the Eustachian tube is very good but if the nasal inflammation is not controlled, the Eustachian tube will close again.
THANK YOU SO VERY MUCH DR. B. You are a blessing.
Hi!! I am a 33y/o who has had a hx of tubes x2. I have significant scaring, per doctors. I have had my adenoids and tonsils removed. Adenoids in toddlerhood and tonsils in adulthood.
What is the literature/studies that show any reoccurrence of OME requiring tubes in adulthood after childhood? If there are any?
I am been dealing with unilateral OME for 5 months now and I am losing my mind! I am hoping that this isn’t going to require tubes since I’ve had 2 sets before and obviously further issues.
Ear problems are due to the eustachian tube and ear tubes do not fix that. Ear tubes are only meant as a temporary fix until the nose and eustachian tube can be addressed. Recurrence of ear infections in adulthood may lead to more severe complications but instead of only focussing on the ear, I recommend you see an allergist for formal testing and management. Your ENT may scope your nose or get CT scans to evaluate sinus disease. There are many other factors that can lead to ear problems, so please discuss with your physicians what measures you can take to improve your eustachian tube functioning. In the meantime, please read my post about Glue Ear and their complications, and the posts about nasal saline washes and my series on sinus infections. Hope these posts will help you in your discussions with your physicians!
I am 49 have ear tube placed in my right ear December 11th, went back for my follow up the ENT stated half of my ear tube was covered with dry blood. the ENT gave me ear drops and told me to place them in my ear twice a day for 10 days to hopefully loosen the scab up. I feel a lot of dripping into my sinuses. I can ear better but not 100% is there anything ELSE I can do to get this scab to fall off sooner vs later ?? Next ENT appointment February 12th – too long to wait in my opium
Sorry for your problems. Hopefully the blood will loosen up with the drops but in many of my patients, depending upon how much blood is there, I need to help remove the scab at the follow-up visit. But your sinus drainage is a separate problem and is most likely the reason you needed tubes in the first place! You might want to check out my posts about allergies, sinus issues and the benefits of nasal saline washes. Discuss with your physician the treatments you may need to do daily, possible allergy testing or xrays. If the nasal symptoms are not controlled, many people need repeated ear tubes. Hoping you feel better soon.
My 5 year old granddaughter had ear tubes put in nearly 2 years ago. She is autistic and cannot verbalize pain. We can see both ear tubes but they are not falling out. We feel she has pain in 1 ear by the way she is acting up. How long do these tubes stay visible and can this create pain?
Standard ear tubes remain in the ear drum up to 2 years. They often fall out into the ear canal and can sit there for years without issues. In kids with sensory concerns, a tube lying in the ear canal and feel abnormal. ENT can remove a tube from the ear canal in the office. If the tube remains lodged in the ear drum, surgery may be needed to removed them. I recommend you get checked out by your ENT as soon as possible to have the tube removed.