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How can I tell if a child needs ear tubes?

By the time your child reaches 3 years old, in all likelihood he or she will have experienced one — if not several — ear infections. In fact, ear infections occur in more than 80 percent of children under the age of 3.

Why are ear infections so common in small children? It’s due to the physical makeup of their middle ear, specifically the eustachian tubes.

Eustachian tubes connect the middle ear to the back of the throat and help regulate air pressure. You know that “pop” you feel in your ear when taking off or landing in an airplane? That’s your eustachian tube opening up and equalizing the pressure in your middle ear.


In babies and small children, eustachian tubes are short and narrow and are prone to not functioning well when a child has a cold that causes their nasal lining to swell. When this happens, fluid and mucous can build up in the middle ear, which causes an infection. Most ear infections are treated with antibiotics or, in minor cases, they can clear up on their own.

Warning signs of an ear infection

If your child is not yet talking, it can be difficult to determine if he or she has an ear infection. While a pediatrician or otolaryngologist (ear, nose and throat specialist) can make an official diagnosis, a few warning signs to look for include:

  • Tugging at the ear(s)

  • Fever

  • Trouble hearing

  • Trouble sleeping

  • Fussiness

  • Problems with balance

  • Fluid draining from the ear

Ear tube surgery

If your child has persistent ear infections, ventilation tubes — which are commonly referred to as ear tubes — might be necessary. I typically recommend ear tubes if a child experiences three ear infections within a six-month period, five ear infections in 12 months or if there is persistent middle ear fluid for three months with hearing loss.

Ear tubes are small tubes (about 1/100 of an inch in diameter) that are surgically inserted into a tiny incision in the eardrum. By bypassing the child’s eustachian tubes and helping equalize pressure in the middle ear, the buildup of fluid that can cause ear infections to develop is prevented.


Ear tube surgery is often referred to as “routine” surgery, but anytime anesthesia is administered to a child — as it is in ear tube surgery — it’s serious. That said, with more than half a million performed each year, ear tube surgeries are the most common childhood surgery. The entire procedure takes only about 15 minutes, complications are often minimal and the child can usually go home within a few hours of surgery.

Ear tubes typically remain in place for 6-18 months and, actually, are often naturally pushed out by the eardrum. So, don’t be surprised if one day you find them sitting on your child’s pillow. I recommend an examination of the ear tubes by the surgeon at least every six months to ensure they are functioning correctly and, later on, are coming out of the eardrum properly.