Children frequently develop middle ear infections because of an immature eustachian tube. Usually after age 3, some kids outgrow this problem; however, there still remain many children who continue to develop infections. If medical management is not effective, ear tubes may bring welcome relief to kids with chronic ear infections. Many parents voice the same ear tube questions over and over and they are important to have addressed prior to surgery.
As a Pediatric Ear Nose and Throat (ENT) surgeon, with over 25 years of experience, I answer ear tube questions on a daily basis. However, I believe parents need to fully understand ear infections, possible ways to reduce them and the possible severe ear infection complications. Once these aspects of ear infections are understood, it is much easier to discuss surgical treatment.
Ear infections should not just be considered a childhood rite of passage! They are indeed extremely common; however, every child in daycare or in a home with smoking adults does not go on to have recurrent infections. Furthermore, many children with severe recurrent infections do not require ear tube placement.
Parents need to remember the Dr. Momma Tip:
The nose is the key to the ear!
Regardless of treatment method, management of ear infections must include a plan to treat the nasal congestion. Ongoing nasal symptoms may not simply be colds and viruses. If recurrent problems continue, evaluations for food allergies, environmental allergies, an enlarged adenoid and sinus problems may need to be performed.
Many of my patients come to my office with several problems including ear infections, constant runny nose, deep wet cough, and vomiting from gastric reflux. Although many symptoms are present simultaneously, the high fever and bulging red ear become the primary focus. Once antibiotics are prescribed for the ear infection, many of other symptoms resolve as well. This makes parents believe that the ear infection caused all the other problems. Nope.
At every consultation for ear tubes, I discuss the many associated symptoms that children have in addition to their ear infections. I love the simple patients with a clear runny nose which progresses only to an ear infection. Those are the children who are magically cured by ear tubes! The other patients may need ear tubes to then allow time to more fully evaluate the other associated symptoms. It can be difficult to assess gastric reflux vomiting when a child may have dizziness from ear infections.
Ear tube surgery can be life-altering for many children. I enjoy receiving hugs and heartfelt thanks when parents come back to my office with happy children who are now talking and walking. Yes, they can have an entirely different disposition when they are no longer in chronic pain!
When a physician recommends surgery, it is normal for parents to have questions. Basic surgery counseling answers many of the common ear tube questions. Prior to your child’s appointment, parents should make sure that they understand the ear tube myths and set their expectations appropriately.
The Top 10 Ear Tube Questions Parents Always Ask
1. Will the tubes stop ear infections?
No. Ear tubes simply provide a drainage site to allow the ear infection mucous to drain from the middle ear. The tubes allow treatment of the infections with ear drops instead of oral antibiotics.
Ear drainage is NOT normal. Many patients never have drainage while others have recurrent episodes. The ear drainage may be clear, yellow, green or even bloody. They all represent middle ear inflammation which is treated with drops.
2. Can children hurt the tubes by putting a finger in the ear?
No, your child cannot hurt or dislodge the ear tubes by inserting fingers into the ear. Ear tubes are inserted directly into the eardrum which is located deep into the ear canal.
If your child inserts a foreign object into the ear, then YES! They could dislodge the tube, but then they could also scrape the ear canal or puncture the eardrum. Needless to say, foreign bodies in the ear canal are discouraged. (This includes Q tips!)
3. Will children know the tubes are there? Can they feel them?
No, typically children cannot feel the tubes once they are inserted. They do not cause pain.
Nevertheless, over time, as the tube is being rejected by the eardrum, dead skin and wax may collect around the tube edges. This collected debris may cause inflammation and intermittent discomfort.
4. Can my child swim without earplugs?
This topic has been debated for years. Each ENT surgeon has an opinion based on their personal experience. I discussed the details of this situation in my post about 5 fantastical ear tube myths.
The basic recap includes a statement from the Academy of Otolaryngology (the governing body for ENT surgeons) which states they do not feel that earplugs are needed. This is a discussion you should have with your child’s surgeon, but I have not recommended any earplugs since 2014.
5. Will my child need more tubes when these fall out?
80% of children who need ear tubes outgrown their problems and never need tubes again. If your child has ongoing allergy, sinus, adenoid or other problems which impact normal functioning of the Eustachian tube, ear infections may recur after the tube are extruded.
6. Can we put long-term tubes in the first time?
Because 80% of children who need tubes, never need a second set, it is extremely uncommon to consider placement of long-term tubes as a first line of treatment
Typical ear tubes are designed to last on average 6 months to one year. Long-term tubes (frequently called T tubes) are designed to last 3-5 years and are reserved for patients who continue with ear problems.
7. Can we insert ear tubes without going to the operating room?
In the emergency room setting, sedation is quite effective to perform procedures because they have the equipment to monitor your child’s breathing and blood pressure. Most doctors’ offices are not set up to monitor children while sedated.
Without sedation, we need to restrain children to perform surgery. Simple restraining does not remove the wiggling and fighting; thus, it increases risks when the surgeon is making a precise incision in the eardrum.
Consequently, for the vast majority of children, the insertion of ear tubes does require general anesthesia.
8. What can I expect from the surgery and can I stay with my child during surgery?
Some pediatric surgical centers allow parents to accompany their children into the operating room until the child goes to sleep, but then the parents are asked to leave. Once your child is asleep, your continued presence requires operating room staff to monitor you!
Why would staff need to monitor you? Because I have seen moms AND dads pass out during procedures on their children. Parents then become the focus of medical treatment which distracts from the focus on children.
Once children awaken from anesthesia, they join you in a postoperative room and remain with you until they go home. Sometimes children wake up crying and upset, but this is normal and should not cause alarm. The effects of anesthesia can range from nausea, vomiting or no symptoms at all.
The surgery itself lasts only 10-15 minutes, and many children are discharged home in an hour.
9. What causes ear tubes to fall out? What if an ear tube is lying in the ear canal?
As the skin on the surface of the eardrum grows, it slowly pushes the tube into the canal. This process is called extrusion.
Once the tube falls into the ear canal, most children never feel them. However, if the ear canal tubes remain for a long time, they may cause skin irritation and need to be removed in the office.
I believe all children with ear tubes should be monitored by their pediatrician or ENT surgeon until the tubes have extruded. Ear tubes that stay in the eardrum longer than normal increase the chances of developing undesirable ear tube complications.
10. What should I expect during the first 24 hours after surgery?
Many ENT surgeons will prescribe ear drops to be used after surgery. It is common to have ear drainage for 3-5 days after the surgery.
If your child has an active cold and ear pain the day of surgery, active middle ear inflammation will be present. A larger amount of mucous and bloody discharge may be expected.
Ear tube surgery is not painful. Teething often hurts more than the surgery. I counsel parents to use pain relievers the same way they did before surgery. The ear tube surgery will add no additional need for pain medication.
Several hours after surgery, most children look and act as if they did not have any surgery. The following day, the kids are free to go back to school, daycare or go on vacation. I do not recommend traveling or attending school the day of surgery.
Ear tube questions are common for parents who are considering the surgery. I urge you to ask questions to your personal ENT physician. If your child has not responded well to medical management of ear infections, I suggest you consider ear tubes as an effective treatment option.
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