If your toddler has experienced ear tugging, a low-grade fever and crankiness for days, you know that few things are worse at this age than an ear infection. But when these painful episodes become more frequent or even chronic, it’s time to speak with the doctor about treatment such as ear tube surgery.
These tiny tubes can help resolve recurrent earaches in childhood and ease your tot's continuing discomfort. Here’s more about how ear tubes work, the pros and cons and how to prepare your child for the procedure if it's right for her.
What are ear tubes?
Ear tubes for children go by several different names, including tympanostomy tubes, ventilation tubes or pressure equalization tubes,[1] and they’re super small — no bigger than a match head. Made from either metal or plastic, ear tubes for toddlers look like little hollow cylinders.
These surgically placed tubes do a powerful job of draining pesky fluid that can accumulate in the middle ear and lead to chronic childhood ear infections. Doctors perform hundreds of thousands of these procedures every year on kids between the ages of 1 and 3 years, though sometimes babies as young as 6 months are candidates for ear tubes.
One or two ear infections are very normal in toddlerhood, but if your child has three in six months or four to five in a year, it’s considered a chronic condition and your pediatrician may recommend ear tube surgery. Other reasons for ear tubes include hearing loss that’s caused by too much fluid or a collapsing ear drum, which can also lead to decreased hearing and erosion of the small bones in the middle ear.
Pros and cons of ear tubes for kids
Ear tube insertion is a pretty simple event but ask the doctor if your tot meets the chronic infection numbers listed and has middle-ear effusion (fluid behind the eardrum). Not every child with recurrent ear infections should get ear tubes. According to the American Academy of Pediatrics (AAP),[2] tube insertion is best for those with hearing problems caused by successive infections.
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As you think about whether ear tubes are right for your child, consider these pros and cons:
Pros of ear tubes
- Ear infections will (mostly) end. Bacteria will have a tougher time breeding once the tubes help trapped fluid to trickle out. The result? Fewer painful ear infections for your little one.
- You can avoid oral antibiotics. On the off chance your tyke does get an ear infection after the tubes are in, the doctor can prescribe antibiotic drops you put into the ear. The tubes allow the drops to go into the middle ear space and clear up the infection.
- Toddler ear tubes relieve tightness. When fluid builds up behind the eardrum, toddlers feel a lot of pressure, much like you feel when you’re on an airplane. Tubes drain the fluid, lessening the tightness.
- Your tot’s hearing and balance may improve. Toddler ear tubes will make sounds louder and clearer as pent-up liquid flows through the tubes. Also, any balance trouble she may have had will get better too. And you might notice better behavior and sounder sleep in your tot after surgery now that she's more comfortable.
Cons of ear tubes
- Ear tubes require surgery. Inserting toddler ear tubes is straightforward enough, but it’s still surgery that takes about 15 minutes to complete and is performed under general anesthesia.[3]
- There’s a low risk of complications. The risks are small for this minor procedure, but they do exist, including bleeding, infections and problems with anesthesia. It’s also possible for the tubes to become blocked with blood or mucus, and they could fall out too early or stay inside for too long, requiring another procedure.
- Toddler ear tubes may be pricey. Most insurance plans cover the tube process when an ear, nose and throat doctor recommends it. Paying out of pocket? The anesthesia and surgery can cost thousands.
- The day of surgery is pretty long. Waiting for your turn at the hospital can be tough on toddlers. Plus, your little one can’t eat or drink before surgery, so she’s likely to be pretty cranky. Try to focus on the end game though, which is a happy child who hears well and gets fewer ear infections.
How to prepare your toddler for ear tube surgery
Be gentle and matter of fact when you explain to your toddler what will happen at the hospital. Here’s what you can tell her about her upcoming ear tube surgery:
- Tell a simple story. Less is more in this case, so keep what you say about ear tube surgery easy to grasp — a detailed, medical description can sound scary. The day before, tell her that the doctor will make her sleepy and then fix her ears. She might be relieved to hear this as she’s aware of the pain her ears can cause.
- Explain how it’s special. Let her know she’ll have to skip breakfast and drinks until she sees the doctor, but she’ll get a snack right after her ears are fixed. Tell her she’ll wear a special gown at the hospital and she can bring her lovey to cuddle with before and after the operation.
- Talk about the anesthesia. Tell her the doctor may ask her to practice her ABCs and 123s while he or she puts a mask over her nose and mouth (and say it doesn’t hurt at all). Pretty soon, she’ll feel sleepy — and then she’ll wake in a room where you’ll be waiting. The anesthesia is probably scarier for you than it is for her, so keep calm while you describe the process.
- Mention the IV if you need to. Many doctors will wait until the anesthesia has taken effect before having a nurse insert an IV, which keeps your child hydrated. If the IV insertion will take place while she’s awake, tell her that you’ll be right there during the quick prick. And be ready with a song or a game to distract her attention ("Do you see any white things in the room? What about blue things?") when it's time.
- Stress that she can go home soon. Toddler ear tubes don’t require a long hospital stay. As soon as the staff rules out any post-surgery complications, which are minor and rare, you’ll be on the way home. While your doctor will likely recommend a quiet afternoon, many kids are playing like they usually do before the day is out.
What happens during ear tube surgery?
Once the anesthesiologist has put your child to sleep, the surgeon will clean out any wax or debris in the ear canal and scan the eardrum. Next, he or she will remove the fluid in her ear by making a small hole in the eardrum and suctioning it out from the middle ear.
The eardrum is reachable via the ear canal and won’t require cuts or stitches that can be seen. The little plastic or metal ear tube is then placed in the hole; the entire operation takes just about 10 to 15 minutes to complete.
What happens after ear tube surgery?
After the surgery is over, staff will move your tot to a recovery room or ward where the nurses can check for complications from the surgery or anesthesia. If none are present, you and your tot can probably go home in a couple of hours. The anesthesia dosage in this case is so small that your tot will likely be up and at 'em within half an hour of going under.
Your toddler may feel a little groggy or nauseated, and she could be cranky or sleepy for the rest of the day — but this should be short-lived. A follow-up visit will take place a few weeks later to check on the placement of the tubes.
You may receive a prescription for antibiotic ear drops to stave off any infection after the placement of ear tubes, and your little one may need to take a hearing test to note any changes post-surgery. (Hearing also tends to improve post-surgery because all that sound-muffling fluid is gone.)
Earplugs in the bath or pool aren’t needed unless the doctor suggests them, and flying in a plane is perfectly fine. In fact, the tubes may even ease the ear pressure felt during altitude changes.[4]
Finish the eardrops as prescribed, and keep your follow-up appointments so the doctor can check on your tot’s ears and hearing.
When to call the doctor
Check in with the pediatrician right away if your child experiences any of the following post-surgery:
- Brown, yellow or blood-tinged discharge from the ear for more than three days
- Pain
- Balance or hearing trouble
- Fever
- Vomiting
- A tube falling out within the first few weeks
Ear tube removal
Ear tubes in toddlers are very low maintenance — and in most cases, removal isn’t even necessary. In general, the tubes stay in for 6 to 18 months and then usually fall out on their own as the eardrum starts to heal.
If a tube falls out too soon, a surgeon may have to reinsert it. Less commonly, your toddler may need another procedure to remove the tubes if they don't drop away on their own.
Ear tubes can be a lifesaver for kids who get frequent ear infections and have trouble hearing. Ask your doctor about this simple procedure and whether your tot is a candidate. And once it’s completed, your child’s hearing and mood should greatly improve.
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