Ear Tubes: Procedure, Recovery and Ear Tubes for Adults

What ear tubes are and how they work

The middle ear is the air-filled space behind the eardrum. It is normally ventilated through the Eustachian tube, a narrow channel that runs from the middle ear to the back of the nose. When this channel does not open properly, air in the middle ear is absorbed, pressure becomes negative and fluid can collect. This is called otitis media with effusion or fluid in the ear (glue ear in children).

An ear tube is a small hollow cylinder, usually made of plastic or silicone and a few millimetres long. Once placed through the eardrum, it acts as an alternative ventilation route: air enters the middle ear from the ear canal, pressure equalises and fluid can drain or be absorbed. Short-term tubes are designed to stay for about 6 to 18 months; long-term tubes, shaped like a T, can stay for years and are used when problems are expected to last longer.

When ear tubes are recommended

Most ear problems in children settle without surgery, so tubes are not the first step. International ENT guidelines suggest considering them in these situations:

Persistent fluid in both ears for three months or more with documented hearing loss.
Recurrent acute ear infections: for example three in six months or four in a year, with fluid still present at the time of assessment.
Children at higher risk of speech or learning difficulties (for example with Down syndrome, cleft palate, or existing hearing or language problems) in whom fluid persists.
Complications such as a retracted eardrum that is getting worse.

In adults, ear tubes may be suggested for fluid that does not clear, for Eustachian tube dysfunction causing pressure, muffled hearing or pain, for people who suffer repeated ear barotrauma when flying or diving, and occasionally after radiotherapy to the head and neck. New fluid in only one ear in an adult always needs an examination of the back of the nose, because a blockage there can be the cause.

The procedure: what happens on the day

Anaesthesia: children have a brief general anaesthetic, usually by mask. Adults can often have the procedure in the clinic with a local anaesthetic applied to the eardrum.
Myringotomy: the surgeon looks through a microscope and makes a tiny incision in the eardrum.
Suction: any fluid in the middle ear is gently removed. Thick fluid is common in glue ear.
Tube placement: the tube is inserted into the opening, where it stays in place by its shape.
Adenoids: in some children who need a second set of tubes or have nasal blockage, the adenoids are removed at the same time.
Duration: the operation usually takes 10 to 15 minutes, and children typically go home the same day.

Recovery and what to expect afterwards

Most people have little pain after ear tubes; simple painkillers are usually enough. A small amount of blood-stained or watery discharge for a few days is normal, and some surgeons prescribe ear drops for a short time. Parents often notice that their child hears better immediately, may talk more loudly at first, or reacts to everyday sounds they had not noticed.

A follow-up visit is usually arranged a few weeks after surgery to check the tubes and test hearing. After that, check-ups every six months or so make sure the tubes are working and see when they come out. Most children can go back to nursery or school the next day.

Swimming, bathing and water precautions

Advice about water has become more relaxed. Current guidelines say that routine ear plugs are not needed for surface swimming or bathing, because water rarely passes through such a small tube. Many ENT surgeons still recommend avoiding diving deeper than about one metre, swimming in dirty lake or river water, and putting the head under soapy bathwater, where soap lowers surface tension.

If an ear starts to discharge after swimming, or your child complains of ear pain, ear plugs or a swimming headband may be useful for that child. For general advice about ear infections and the pool, see can you swim with an ear infection.

Possible problems and how they are treated

Discharge (otorrhoea): the most common issue. A tube makes infections easier to treat because drops can reach the middle ear. Antibiotic ear drops are usually the first treatment, not oral antibiotics.
Blocked tube: dried blood or mucus can block the tube; drops can sometimes clear it.
Early extrusion: the tube can fall out before the fluid problem has resolved, and a second set may be needed.
Persistent hole: in a small number of people the eardrum does not close after the tube comes out. Small holes may cause no symptoms; larger ones can be repaired. See perforated eardrum.
Eardrum scarring (tympanosclerosis): white patches on the eardrum are common and rarely affect hearing.
Tubes that stay too long: tubes still in place after two to three years may be removed.

Ear tubes for adults: specific points

In adults the operation is usually quicker and often done awake. The ENT specialist first looks for the cause of the fluid, including allergies, chronic rhinitis, reflux, enlarged structures at the back of the nose and, rarely, a tumour of the nasopharynx. Adults often notice immediate relief of pressure and muffled hearing.

Tubes in adults tend to be used when other measures have failed: nasal steroid sprays for nasal inflammation, autoinflation (blowing up a balloon through the nose) and treatment of the underlying cause. In selected patients with Eustachian tube problems, a newer option called balloon dilation of the Eustachian tube may be discussed.

When to contact the doctor after ear tubes

Ear discharge lasting more than a week despite drops, or bloody or foul-smelling discharge.
Fever with ear pain or redness and swelling behind the ear.
Hearing that gets worse again, or a child who seems not to hear well.
Dizziness or balance problems.
The tube is seen in the ear canal or on the pillow before a check-up (not urgent, but worth reporting).

Key points to remember

Ear tubes ventilate the middle ear and let fluid drain.
They are used for long-lasting fluid with hearing loss and repeated infections, in children and adults.
The procedure is short and recovery is quick.
Most tubes fall out on their own and the eardrum heals.
Discharge is the most common problem and is usually treated with antibiotic drops.

Questions about ear tubes

These answers are general information and do not replace an examination or individual medical advice.

How long do ear tubes stay in?

Standard tubes usually fall out by themselves in 6 to 18 months. Long-term tubes can stay for several years.

Are ear tubes painful?

Pain after the procedure is usually mild and settles within a day or two with simple painkillers.

Can adults get ear tubes?

Yes. Adults with persistent fluid, Eustachian tube dysfunction or repeated barotrauma can have tubes, often with local anaesthetic in the clinic.

Can my child swim with ear tubes?

Most children can swim at the surface without ear plugs. Avoid deep diving and dirty water unless your ENT surgeon says otherwise.

Will my child need tubes again?

Some children need a second set if fluid returns after the first tubes come out; adenoid removal may be considered then.

What happens if a tube falls out early?

It is not an emergency. Contact your ENT team, who will check whether fluid has returned.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.