Chronic Ear Infections: When to Consider Ear Tubes

Ear infections are a common complaint in childhood that usually resolve with simple treatment. But if chronic ear infections become an issue, a quick outpatient procedure can often treat and prevent them.

What Causes Ear Infections?

The ear produces fluid that drains through the eustachian tube – a small tube that connects the middle ear to the back of the throat. If the eustachian tube is swollen or blocked, fluid can build up behind the eardrum. This creates the perfect environment for a bacterial infection in the middle ear. Known as otitis media, it’s the most common type of ear infection.

Why Are Ear Infections So Common in Children?

“Babies and young children often have eustachian tubes that are shorter, narrower or lay more horizontally than those in adults. This limits the tube’s ability to drain fluid from the middle ear and increases the risk of fluid buildup behind the ear drum,” says Jay Shah, MD , pediatric otolaryngologist at UH Rainbow Babies & Children’s.

“The eustachian tubes often self-correct as a child grows. But in the meantime, the resulting ear infections can cause inflammation and pain that requires treatment. If infections are frequent, they can lead to more serious consequences including dizziness, balance problems, hearing loss, delayed speech or a ruptured ear drum. In severe cases, the infection may spread to the brain or inner ear,” adds Dr. Shah.

Symptoms of an Ear Infection

In children older than six months, ear infections can often be managed at home with over-the-counter pain relievers. Babies younger than six months old with any of the following symptoms should always be evaluated by a pediatrician:

• Swatting, tugging or pulling at the ear(s)
• Increased fussiness and/or crying
• Difficulty falling and staying asleep
• Fever

When to See a Specialist

“If your child is diagnosed with recurrent ear infections, defined as three infections within six months or four infections within one year, it’s time to talk to a specialist,” says Dr. Shah.

“Typically, ear infections are treated with oral antibiotics. But we want to avoid overuse of antibiotics in children so they don’t develop a resistance to the drugs. For children with recurrent ear infections, the placement of ear tubes may be the recommended treatment.”

Ear Tube Placement

Also known as tympanostomy, ear tube surgery is the most common childhood surgery performed in the United States. The procedure is done under general anesthesia and typically takes less than 15 minutes.

Once your child is asleep, the doctor makes a tiny incision in each eardrum and inserts a small, hollow tube. The tube increases air flow into the middle ear and promotes drainage to prevent fluid from accumulating. Complications are rare and children typically go home the same day, with little to no pain after the procedure. The tiny incisions typically heal quickly.

Ear tubes are designed to fall out in 6-18 months. If ear infections continue, further evaluation or a repeat procedure may be needed.

Making the Decision

“Putting your child through any kind of surgical procedure can create anxiety,” says Dr. Shah. “However, ear tube insertion is a very safe and effective way to reduce ear infections in select children, avoid more serious complications like hearing loss and limit antibiotic use. I always recommend that parents have an in-depth conversation with their child’s healthcare provider about the benefits and risks to help them make the right decision for their child.”

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University Hospitals Rainbow Babies & Children’s has a wide network of pediatric otolaryngologists at convenient locations across the region. Our experts have advanced training in the diagnosis and treatment of ear, nose and throat problems in children, including chronic ear infections.