Myringotomy and Ear Tubes

What is a Myringotomy and Tube Placement?

A myringotomy is a small surgical opening created in the eardrum (tympanic membrane). This allows the surgeon to remove fluid trapped in the middle ear (the space behind the eardrum) and place a tiny ventilation tube—also known as a tympanostomy tube, grommet, or pressure equalization (PE) tube.

The middle ear is a small space behind the eardrum that normally contains air. It is connected to the back of the nose by the Eustachian tube, which equalizes air pressure. If this system doesn’t work properly, fluid may build up or repeated infections may occur. You can learn more about the Eustachian tube and the ventilation of the ear in this article.

The purpose of the tube is to bypass the Eustachian tube temporarily, allowing air to enter the middle ear and fluid to escape. This restores balance through the tube (instead of through the Eustachian tube) and improves hearing.

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 Who Needs a Tube? (Indications)

Ear tubes are not needed in all patients with ear problems. ENT specialists recommend them in specific situations where other treatments (like antibiotics, nasal sprays, sinus irrigation or simply waiting) are not enough:

1. Recurrent ear infections (acute otitis media). This indication is one of the most common reason to place a tube in children.

   • For patients that have 3 or more infections in 6 months, or

   • For patients that have 4 or more infections in a year, with at least one infection in the past 6 months.
     Tubes help reduce infection frequency and the need for antibiotics.

2. Chronic middle ear fluid (otitis media with effusion)

   • Fluid that persists behind the eardrum for longer than 3 months will require a tube for drainage.

   • This fluid often causes muffled hearing or “underwater” sensation.

   • In children, it can interfere with speech development and school performance.

3. Hearing loss due to fluid buildup

   • Even if infections are not frequent, chronic fluid can reduce hearing by 20–30 decibels (like wearing earplugs all day). This is even more important in young children who are developing their language.

4. "Baro-challenge" ear problems

   • Inability to equalize pressure during flights, or mountain driving, often due to poor Eustachian tube function.

   • The ear tube will ventilate the ear and fix these symptoms. 
     
     

5. Persistent Eustachian tube dysfunction

   • When the tube connecting the ear to the throat fails to work properly, causing fullness, popping, or fluid buildup.

* For some of these indications, an alternative option to the ear tube is Eustachian tube dilation. This procedure opens the natural Eustachian tube passage, helping restore normal function without inserting any foreign object into the ear. You can learn more about Eustachian tube dilation in this article.   

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Types of Tubes and Their Duration

Not all tubes are the same—different designs are chosen based on the condition and treatment goals.

• Short-term tubes

  • Small, usually shaped like a tiny hollow cylinder.

  • Last 6–18 months on average before they naturally fall out.

  • Often used in children with recurrent infections, or for adults that need a temporary solution to their ear problems.

  • The eardrum usually heals quickly after the tube falls out.
    
    

    
  
  
  

• Long-term tubes

  • They are longer and shaped like a “T” with "flanges" that hold the tube more firmly under the eardrum

  • Designed to stay in place for more than 18 months. The duration can vary but on average can stay 2–3 years or longer.

  • Used in patients with severe or persistent Eustachian tube dysfunction, or patients who have needed multiple sets of short-term tubes that repeatedly fall out, with fluid returning each time.

    
    
    
• Permanent (subcutaneous or subannular) ear tubes. 
  
  
  • These are differently inserted, in a skin tunnel under the eardrum (not through the eardrum). You can read about this type of tube in this article.
    
    

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Steps of the Procedure (Office-Based in Adults)

For adults, we perform myringotomy and tube insertion right in the office, avoiding the need for general anesthesia. Here’s what happens:

1. Preparation

   • The ear canal is carefully cleaned.

   • A numbing agent (local anesthetic) is injected in the outer ear with a small needle. That numbing agent will freeze the ear and the eardrum. This part will sting a little. The rest of the procedure is pain-free.

2. Myringotomy (incision)

   • A very fine instrument makes a tiny opening in the eardrum.

   • The incision is 2-3 millimeters wide at the most.

3. Fluid removal

   • Any fluid (clear, mucoid, or pus-like) is gently suctioned out.

   • This step alone will improve hearing immediately.

4. Tube placement

   • A ventilation (or pressure equalizing) tube is carefully positioned in the incision.

   • The tube acts like a “tiny straw” to keep the hole open and allow air exchange.

5. Recovery

   • Antibiotic drops are applied in the ear canal, and a cotton ball in placed in the outer ear. 
     
     

   • The procedure typically takes 5 minutes per ear.

   • Most adults can resume normal activities the same day.

   • You will likely receive a prescription for antibiotic ear drops to use for a few days after the procedure. 
     
     
   • Pain management is done with Tylenol or Advil (not a very painful procedure, similar to a minor dental procedure once the numbing wears down).    
     
     
   • You can expect some pink or blood-tinged discharge for a few days after the procedure. Persistent discharge for more than a week would be abnormal and you should consult your doctor. 

In children, the same steps are followed, but the procedure is usually done under general anesthesia for comfort and safety. Sometimes, it is possible to put a tube under local anesthesia in very young children (under 2 years of age), but it requires a good patient and cooperative parents. 

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Risks and Benefits of the Procedure

1. Benefits

• Fewer infections: Reduces the frequency and severity of ear infections.

• Better hearing: Especially when hearing loss was caused by middle ear fluid.

• Relief of ear pressure: Especially when it was caused by middle ear fluid.
  
  

• Less antibiotic use: Helps avoid repeated courses of oral medication. Instead, the next time there is an ear infection, antibiotic drops can be used (which have minimal to no side effects).

• Improved quality of life: Better sleep, school performance, speech development (in children), and less ear pain during pressure changes.

2. Risks 

• Persistent perforation: In up to 10% of cases, the eardrum may not close after the tube falls out. This is even more common in the long-term type of tube. Most often, the hole can close on its own after a few months, but if it doesn't then surgical repair would be necessary. This is probably the most important drawback of these tubes.

• Persistent ear drainage (otorrhea): Intermittent ear discharge with allergies or during colds is normal, as the tube is doing its job (which is draining the ear and preventing fluid build up). However, some patients may notice persistent fluid or pus discharge. This is not normal but usually responds to antibiotic drops.

• Tympanosclerosis (scarring): Small white patches on the eardrum may develop once the eardrum heals, but rarely affect hearing.

• Repeat procedures: Some patients need new tubes if problems return after the first set falls out.

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Precautions with Tubes in Place

• Water precautions:

  • For most patients, swimming in teated waters (such as clean pools) is safe with no protection (small risk of infection)

  • It is also safe to take showers with no specific precautions. 

  • In untreated water (lakes, rivers), earplugs are advised to avoid water infiltration through the tube and ear infections. 

  • Deep diving (such as scuba diving) should generally be avoided. Water penetrating through the tube and reaching the middle ear could cause dizziness that would be very dangerous while diving.

  • Flying is safe with ear tubes. The tubes help equalize pressure changes during flights, making air travel more comfortable—this is actually one of the main reasons ear tubes are recommended for people who have trouble with pressure when flying.  
    
    

• Ear hygiene:

  • There is no specific hygiene that is needed while tubes are in place. 

• • Never insert cotton swabs, hairpins, or other objects into the ear canal. This can push bacteria inward or damage the tube.

• Monitor for drainage:

  • Any persistent fluid, pus, or foul odor should be reported to the ENT doctor.

  • Infections can still occur but are easier to treat with drops.

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Medical Follow-Up After Tube Placement

Follow-up is an essential part of ear tube care:

• First visit: 4–6 months after initial placement, to ensure the tube is in position and the ear is healing well.

• Ongoing monitoring: Every 6 months, or sooner if problems arise. This is important to make sure there are no complications with the tube, to monitor when the tube falls off (called "extrusion"), and the make sure the eardrum heals appropriately afterwards.

• Tube extrusion: Short-term tubes usually fall out on their own. Long-term tubes may need surgical removal.

• Eardrum healing: After extrusion, the eardrum usually closes naturally. If it does not, a minor surgical repair may be necessary.

Regular follow-up allows the ENT to track hearing, ensure the tube remains open, and detect any complications early.

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Conclusion

Myringotomy and tube placement is one of the most effective treatments for chronic middle ear problems, offering quick relief and long-term benefits with very little risk. With proper care, most patients experience fewer infections, better hearing, and an overall improvement in quality of life.