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How Many Ear Infections Before Tubes In Toddlers

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When Does My Child Need Ear Tube Surgery

When to get ear tubes for kids

Tubes are placed when a child has recurrent or chronic ear infections . Tubes are generally recommended when a child has three infections in six months; four infections in one year; or persistent ear fluid lasting three months or more with associated hearing loss. Your ENT specialist can help determine if ear tubes are needed.

Who Are At Risk

The following toddler groups can have a higher susceptibility to develop middle ear infection:

  • Prematurely born: Paediatric experts note that infants born prematurely have a higher risk of developing middle ear infections. The high risk is attributed to the slow development of the immune system and eustachian tube not fully developed .
  • Exposure to smoke and pollution: Chronic exposure to tobacco smoke and vehicular effluents makes the toddler more susceptible to ear infections.
  • Toddlers at daycare: Toddlers who spend a bulk of their time at daycare centers have a higher risk of contracting colds and throat infections, due to droplet infections which can lead to ear infections.

It is vital to spot the symptoms of ear infection in toddlers to initiate quick treatment and mitigate discomfort.

What Happens If My Child Keeps Getting Ear Infections

To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics arent helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out.

If placement of the tubes still doesnt prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.

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What Happens During Ear Tube Placement

Your child may be given a medication to help him or her relax prior to entering the operating room . In the operating room, the anesthesiologist will usually use a mixture of gas and an intravenous medication for sedation. During the procedure, which typically takes 10 to 15 minutes, your child will be continuously monitored including pulse oximeter and cardiac rhythm . The surgical team is prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room.

After the anesthetic takes effect, the doctor, using an operating microscope, makes a tiny incision in the eardrum through the outer ear canal. There will be no external incisions or stitches. Fluid will be suctioned from the ear, and a tube inserted in the eardrum. Usually, drops will be placed in the ear, and a cotton plug inserted in the ear canal.

An appointment for a follow-up ear check-up is usually arranged 14 to 28 days after the procedure. At this visit, the position and function of the tubes will be assessed.

You can “pump” them into the ear by pushing on the soft cartilage tissue located in front of the ear canal .

Ear drainage may occur immediately after the procedure or at any time while the tubes are in place.

Yellow clear fluid or mucous may drain for several days to weeks after the surgery.

It is not unusual to see a bloody discharge following surgery. Cotton can be kept in the ear canal and changed as needed to keep dry.

Why It Is Done

3 Ear Tubes Surgery

Placing tubes in the ears drains the fluid and ventilates the middle ear. Tubes may keep ear infections from recurring while the tubes are in place. They also keep fluid from building up behind the eardrum. Doctors consider surgery to insert tubes:

  • If a child has had fluid behind the eardrum in both ears for more than 3 months and has significant hearing loss in both ears.
  • If a child has repeat ear infections.

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What Is The Purpose Of Ear Tube Placement

Middle ear infections are common in children. When a child has repeated ear infections or fluid build-up in the ears that do not go away easily or there are hearing problems or speech delays, a doctor may recommend surgery to insert an ear tube to allow the eardrum to equalize the pressure.

The surgery, called a myringotomy, is a tiny incision in the eardrum. Any fluid, usually thickened secretions will be removed. In most situations, a small plastic tube is inserted into the eardrum to keep the middle ear aerated for a prolonged period.. These ventilating tubes remain in place for six months to several years. Eventually, they will move out of the eardrum and fall into the ear canal. Your doctor may remove the tube during a routine office visit or it may simply fall out of the ear.

Less common conditions that may call for the placement of ear tubes are malformation of the eardrum or Eustachian tube, Down’s syndrome, cleft palate, and barotrauma , according to the American Academy of Otolaryngology.

What Happens During Ear Tube Insertion For A Child

The surgery to place ear tubes in your childs ear is called tympanostomy. It takes about 15 minutes. This procedure may include the following:

  • Your child will get general anesthesia.;Your childs healthcare team will watch him or her closely.

  • The surgeon will make a small opening in your childs eardrum. This is done to drain the fluid and relieve the pressure from the middle ear.;

  • The surgeon places a small tube in the opening of the eardrum. This lets air flow into the middle ear. It also keeps fluid from building up.

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What To Expect After Surgery

Tubes can be inserted in an outpatient surgery clinic. Children usually recover quickly and have little pain or other symptoms after surgery. Children can usually go home within 1 to 2 hours after the surgery. Your child will probably be able to return to school or child care the next day.

Follow-up visits to the doctor after a child has tubes inserted are very important. The doctor checks to see whether the tubes are working and whether the child’s hearing has improved.

Ask your doctor if your child needs to take extra care to keep water from getting in the ears when bathing or swimming. Your child may need to wear earplugs. Check with your doctor to find out what he or she recommends.

Tubes normally remain in the ears for 6 to 12 months. They often fall out on their own. If the tubes don’t fall out on their own, your child may need surgery to remove them. After the tubes are out, watch your child for signs of ear infection or fluid behind the eardrum.

Can You Still Get Ear Infections With Tubes

Ear tubes – when is it time?

While ear tubes may reduce the number of ear infections, they don’t stop infections completely. If your child does get an ear infection, there will be ear drainage and antibiotic ear drops can treat the infection. Ear drops are more effective and have fewer side effects than oral antibiotics. Children with ear tubes can use these drops, a major benefit of ear tube surgery.

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Are My Childs Ear Infections Chronic

As you and your child wake up to yet another ear infection, you may wonder if your childs ear infections are considered chronic. In response to the same questions, Dr. Horton noted that the criteria they use is three infections over 6 months or four infections over one year. Yup, thats us, you sigh quietly to yourself. Dont worry, there are options for how to address your childs overachieving ear canals.

How Are Ear Infections Treated

Ear pain

Here are some antidotes to help you get through the night:

  • or ibuprofen are effective pain relievers for ear pain. You can safely use both medications together if one alone is not enough. Click on each medication for the dosage.
  • Warm compression apply a warm washcloth to the ear.
  • Warm olive oil, vegetable oil, or garlic oil put several drops of one of these into the ear. MAKE SURE THE OIL ISNT TOO HOT.
  • Anesthetic eardrops if the above remedies arent enough, these are available by prescription and can numb the eardrum to minimize the pain for an hour or two.
  • WARNING if you see any liquid or pus draining out of the ear, DO NOT PUT ANY OF THE ABOVE DROPS INTO THE EAR. See below under ear drainage.

Xylitol and ear infections

Xylitol helps fight the bacteria causing the infections, much of which is in the nose.

  • Chewing gum sweetened with xylitol has been shown to reduce some chronic ear infections .
  • Xlear® is a nasal spray containing xylitol that was originally developed to prevent ear infections. Using it will help keep your childs nose clean and wash out many of the bacteria that cause these infections.


A seven-day course is the current recommendation unless your doctor feels a longer course is indicated. The whole issue of antibiotics can be confusing to parents, so here are some general guidelines to help you:

Avoid antibiotic resistance

When to use a stronger antibiotic

Ruptured eardrum

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Lets List The Pros And Cons

Recurring or chronic ear infections can lead to damage of the middle ear and potential hearing loss. Even if the damage isnt permanent, impaired hearing can delay speech development in your child, according to Dr. Horton. Below, he outlined these pros and cons for parents considering ear tubes for their child.

  • Better quality of life

When It Comes To Your Child Where You Take Them Matters

How many ear infections will it take before my child needs ...

If your child has ear infections, strep throat or other issues that impact their ears, nose or throat, find a pediatric otolaryngologist or click the link below to schedule an appointment.

Steven Goudy, MD, is Medical Director of Otolaryngology at Childrens Healthcare of Atlanta, as well as Professor and Director of Pediatric Otolaryngology at Emory University School of Medicine. He joined Childrens in 2015 by way of Vanderbilt University Childrens Hospital, where he worked for 10 years following his fellowship training in pediatric otolaryngology.

This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Childrens Healthcare of Atlanta team are independent providers and are not our employees.

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How Does A Doctor Diagnose A Middle Ear Infection

The first thing a doctor will do is ask you about your childs health. Has your child had a head cold or sore throat recently? Is he having trouble sleeping? Is she pulling at her ears? If an ear infection seems likely, the simplest way for a doctor to tell is to use a lighted instrument, called an otoscope, to look at the eardrum. A red, bulging eardrum indicates an infection.

A doctor also may use a pneumatic otoscope, which blows a puff of air into the ear canal, to check for fluid behind the eardrum. A normal eardrum will move back and forth more easily than an eardrum with fluid behind it.

Tympanometry, which uses sound tones and air pressure, is a diagnostic test a doctor might use if the diagnosis still isnt clear. A tympanometer is a small, soft plug that contains a tiny microphone and speaker as well as a device that varies air pressure in the ear. It measures how flexible the eardrum is at different pressures.

How Long Will It Take My Child To Get Better

Your child should start feeling better within a few days after visiting the doctor. If its been several days and your child still seems sick, call your doctor. Your child might need a different antibiotic. Once the infection clears, fluid may still remain in the middle ear but usually disappears within three to six weeks.

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What Are The Treatment Options

Observation and medical management are typically the first steps of treatment. Your ENT specialist will help you decide when, and if, ear tubes are the best option for you and your child.

Ear tubes are inserted during an outpatient surgical procedure called a myringotomy with tympanostomy tube insertion. A myringotomy refers to a small incision made in the ear drum or tympanic membrane, which is most often done under a surgical microscope with a small scalpel. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space .

During Surgery

Most young children require general anesthesia. Some older children and adults may also be able to tolerate the procedure with only local anesthetic. An incision is made on the ear drum and the fluid behind the ear drum in the middle ear space is suctioned out. The ear tube is then placed in the opening. Ear drops may be administered after the ear tube is placed and may be prescribed for a few days. The procedure usually lasts less than 15 minutes and patients recover very quickly.

Sometimes the ENT specialist will recommend removal of the adenoid tissue when ear tubes are placed for persistent middle-ear fluid. This is often considered in children over the age of four, or when a repeat tube insertion is necessary.

After Surgery

What To Expect From Ear Tube Placement

Sound Advice on Ear Tubes

Myringotomy is the surgical procedure that is performed to insert ear tubes. Ear tube placement is usually an outpatient procedure. This means that your child will have surgery, and then go home that same day. The procedure usually takes about 15 minutes and is done under general anesthesia.

Myringotomy involves making a small opening in the eardrum to drain fluid and relieve pressure from the middle ear. A small tube is then placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The tubes usually fall out on their own after 9 to 12 months.

Fortunately, ear tubes require relatively little follow-up. After the surgery, children return to their surgeon’s office a month after the procedure, then every six months after that until the ear tubes fall out. By that point, many children outgrow their ear problems and don’t require additional sets of tubes.

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Signs Your Child May Need Ear Tubes

Ear tube surgery, also known as tympanostomy tube insertion surgery, is the most common childhood surgery performed in the United States. At The Childrens Hospital of Philadelphia alone, surgeons in the Division of Otolaryngology surgically implant ear tubes in more than 4,000 children each year at CHOPs Main Hospital;and the CHOP Specialty Care Center & Surgery Centers in Brandywine Valley, Bucks County, King of Prussia and Voorhees.

For children plagued by ear infections from an early age, ear tubes offer many benefits. These tiny cylinders, usually made of plastic and sometimes metal, are surgically inserted into your childs eardrum. This allows air to flow in and out of the middle ear, which improves the health of the middle ear and typically reduces the number of ear infections.

But just because your family has suffered through some late nights and gone through several courses of antibiotics for ear infections, that doesnt necessarily mean ear tube placement is the best option. We dont recommend ear tube surgery for every single child with an ear infection, says Brian P. Dunham, MD, an attending surgeon in the Division of Otolaryngology. Often, antibiotics and other non-surgical treatments are better suited for children who have occasional ear infections. ;

Generally, Dr. Dunham and other doctors at CHOP will recommend ear tubes if your child:

What Should I Do For My Child After Ear Tube Surgery

You and your child should be able to return home within one to two hours following ear tube surgery. Children usually have little pain or other symptoms following the procedure. Your doctor will examine your childs ear tubes every six months to make sure the tubes are in place.Ear tubes will fall out on their own after 12 to 36 months. As children grow older, they have longer and wider Eustachian tubes, which naturally allow better drainage of fluids from the ear in addition to the maturation of their immune systems.Ear plugs are not required for bathing or swimming in bathtubs or chlorinated pools, but are recommended if your child swims in lakes or oceans.

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