Expert Advice -- Will Ear Tubes Prevent Ear Infections?

My three-year-old daughter has had ear tubes in place since she was 20 months old and has been doing fine. A week ago she complained of ear pain. We took her to her doctor, and she had an ear infection. The tubes are still in place, but the infection occurred. How can this be possible?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Ear infections occur when the fluid within the middle ear becomes infected. The runny nose of a typical viral upper respiratory infection is often accompanied by fluid also within the middle ear. Most of the time this fluid either runs down the Eustachian tube or is reabsorbed by the body. However, occasionally (sometimes more than just occasionally as frustrated parents may tell you) the inflammation commonly noticed in the nose and throat also occurs within the Eustachian tube, causing it to close off. This traps the fluid in the middle ear. If this fluid becomes infected with bacteria, the child experiences an ear infection.

Ear tubes are placed to essentially give the fluid a new way out of the middle ear when the Eustachian tube isn't doing its job. If the fluid isn't present, then there shouldn't be any ear infection, which is why ear tubes tend to be so effective in preventing them. But like most things in medicine, ear tubes are not foolproof. So, here are the most common reasons why ear tubes sometimes fail to prevent subsequent ear infections:

• The tube is blocked -- Ear tubes stick through the ear drum, allowing a tunnel for fluid to drain. The tubes usually stay in place an average of 9 to 12 months, but they are only effective if they are not plugged. Mucous and ear wax can sometimes block these very tiny tubes, rendering them ineffective at draining fluid.

• The fluid accumulation is large -- The tubes can only transfer so much fluid at one time. Sometimes, the fluid accumulates within the middle ear so fast that complete drainage cannot occur. Then, if bacteria gets in ... Well, you know the story.

• The fluid in the middle ear is thick -- If the fluid in the middle ear becomes somewhat viscous, flow through the tube becomes much slower.

• Bacteria makes it way through the tube -- Occasionally, bacteria from the external ear canal can make it through the tube creating an ear infection with large amounts of thick, smelly fluid.

As you can see, ear tubes only help decrease the number of ear infections, not completely eliminate them. Your three-year-old has had her tubes last for a longer time than most children and you imply they have done a pretty good job thus far at preventing ear infections. Unfortunately, the tubes aren't perfect but are sometimes the best option for many children who have had unrelenting ear infections.

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