Does Your Child Need Ear Tubes? 3 Ways To Know.


If you have young children, you’re probably familiar with ear aches, ear infections and fluid build-up in the middle ear, all of which can cause pain, crying, fussiness and more than a few sleepless nights, for everyone. Ear problems like these cause many of our parents here at Westchester Health Pediatrics to ask us if their child should get ear tubes.

Lauren Adler, MD, FAAP

Our answer, of course, is that it depends on the child. We don’t recommend ear tube surgery for every child with an ear infection. For some, ear tubes may indeed be the best treatment. For others, they’re not needed.

As a parent, how do you know? To help you decide which would be best for your child, we’ve pulled together some important information, explanations and guidelines from several sources so you can be more informed.

American Academy of Otolaryngology guidelines for ear tubes

Ear tube surgery, also known as tympanostomy tube insertion surgery, is the most common childhood surgery performed in the United States with anesthesia, according to a report by the Children’s Hospital of Philadelphia. In this hospital alone, surgeons surgically implant ear tubes in more than 4,000 children each year.

To help physicians and parents determine whether all these surgeries are actually necessary, a multidisciplinary panel associated with the American Academy of Otolaryngology-Head and Neck Surgery Foundation released new guidelines in 2013 regarding ear tubes in children ranging in age from 6 months to 12 years, as reported by Caitlin Hagan, CNN Medical Associate Producer. The panel included pediatricians, a nurse practitioner, an anesthesiologist, a speech pathologist, consumer advocates and ear, nose and throat specialists, among others.

According to the AAO-HNSF guidelines:

  • Children who have very frequent ear infections and whose ears tend to retain fluid are good candidates for ear tubes.
  • However, the guidelines advise that tubes should not be given to children who have frequent ear infections but who do not have fluid build-up, a major deviation from the way most pediatricians treat these cases.

The AAO-HNSF recommends that parents should question their pediatrician about whether their child’s ears retain fluid. If they do not, ear tubes should be avoided.

Who should get ear tubes? Children who:

  1. Have had three or more ear infections within six months, especially if they retain fluid in between the episodes
  2. Have ear infections that are not resolved with antibiotics
  1. Have ear infections that are affecting their gross motor skills and/or balance
  2. Are experiencing hearing loss caused by the persistent build-up of fluid in the middle ear
  3. Have a collapsing eardrum, a condition known as atelectasis which causes decreased hearing and can also erode the bones in the ear
  4. Are at higher risk for fluid build-up-related developmental delays, including those with autism, permanent hearing loss, Down syndrome, cleft palate or any other developmental delay
  5. Have malformation of the eardrum or eustachian tube that inhibits drainage of the middle ear

How ear tubes work

For children who suffer from ear infections from an early age, ear tubes can be a very effective solution. The average age for ear tube insertion is one to three years old.

Usually made of plastic, these small tubes (1/20th of an inch) are surgically inserted into the tympanic membrane (ear drum) while the child is under light anesthesia. This allows air to flow in and out of the middle ear, which typically reduces the number of ear infections by ventilating and eliminating the pressure inside the middle ear. A child should not be able to feel the tubes while they’re in the ear.

Ear tubes come in two basic types: short-term and long-term. Short-term tubes are smaller and typically stay in place for 6-18 months before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist may be necessary.

The good news is that children with ear tubes are able to play in water, swim and bathe without wearing earplugs. If the water is more than six feet deep, a child with ear tubes should wear ear protection.

Inserting ear tubes has been shown to:

  1. Reduce the occurrence of future ear infections
  2. Restore hearing loss caused by a build-up of middle ear fluid
  3. Improve speech problems and balance problems
  4. Improve behavior and sleep problems caused by chronic ear infections
  5. Help children do their best in school

To learn more

For more information about ear tubes and ear infections, you might find this article from the American Academy of Otolaryngology-Head and Neck Surgery Foundation helpful.

If you think your child may need ear tubes, please come see us

If your child is having persistent ear infections or other problems with his/her ears, please make an appointment with Westchester Health Pediatrics to see one of our pediatricians. We’ll examine your child and together with you, choose the best treatment to clear up the condition, which may or may not include ear tubes. Whenever, wherever you need us, we’re here for you.

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By Lauren Adler, MD, FAAP, a pediatrician with Westchester Health Pediatrics, member of Northwell Health Physician Partners

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About the Author: ML Ball