If your child has had multiple ear infections, you're not alone. Ear infections are among the most common reasons parents bring their children to the doctor.
When do repeated ear infections warrant a trip to an ear, nose and throat (ENT) specialist? And when might ear tubes be the right solution? Ilaaf Darrat, M.D., a pediatric otolaryngologist at Henry Ford Health, answers parents' most pressing questions about ear infections and ear tubes.
Why Are Ear Infections So Common in Kids?
Young children are particularly prone to ear infections for several reasons. “Kids are constantly putting toys, hands and other objects in their mouths, and they’re still learning good hand hygiene,” says Dr. Darrat. “These factors make it easier for germs to spread between children and from surfaces into their bodies. In addition, common viral infections like the flu or RSV can inflame the upper airway and make it easier for bacteria to grow in the middle ear.”
But it's not just about germy hands and toys. The anatomy of a child's ear also plays a major role. The Eustachian tube, which connects the ear and throat, doesn't function as well in young children.
“Young children often have Eustachian tubes that don’t clear out fluid very well,” Dr. Darrat explains. “Immature Eustachian tubes are more horizontal instead of diagonal, so gravity cannot help the fluid drain from their ears down into their throat.”
How Long Do Ear Infections Last?
With proper treatment, your child should start to feel better quickly. “You should see improvements within 24 hours of starting antibiotics,” says Dr. Darrat. “The pain and fever should be significantly less.” If your child isn't getting better after 24 hours of medication, contact your healthcare provider.
When Should You Consider Ear Tubes?
There's no magic number of ear infections that automatically means your child needs tubes. “The decision to get tubes depends on your child’s overall health and medical needs,” says Dr. Darrat. “We need to determine whether your child could have complications from ear infections, or whether they heal quickly without any long-term issues.”
For example, a child who gets several ear infections in a year may not need tubes if they:
- Have no hearing loss or developmental delays
- Naturally clear fluid out of their ears between infections
- Respond well to antibiotics
However, a child who has just one or two ear infections may need tubes if they have:
- Fluid in the ear that persists for 3 months or more
- Hearing problems
- Neurological or developmental conditions, such as autism or Down syndrome
- Speech delays
Another red flag is drug-resistant bacteria. Some types of ear infection-causing bacteria don’t respond to the standard antibiotics doctors prescribe for ear infections.
“If we’ve gone through every oral antibiotic and they’re not working, we usually consider ear tubes,” Dr. Darrat says. “The goal is to avoid serious complications and the need for intravenous or intramuscular antibiotics, which are the next step after oral medications.”
Pediatric ENT Care
How Do Ear Tubes Work?
Many parents misunderstand the purpose of ear tubes. “The tubes don't prevent ear infections,” Dr. Darrat explains. “They help us treat the ear infection and clear any fluid that might be causing hearing loss.”
Doctors insert the tube through the eardrum, creating a tiny opening that allows fluid to drain out into the ear canal. “It's like putting an open window in to let it drain so it doesn't get trapped behind the eardrum,” says Dr. Darrat.
If your child gets an ear infection with tubes in place, you may see drainage from their ear. “Parents are often more disturbed than the child because they may see pus coming out of their ear,” Dr. Darrat says. “That pus means the tubes are working. They’re getting that infection out. Usually, your child won’t be in pain or have a fever.”
Tubes are not a permanent fix, and most children outgrow the need for them. Typically, ear tubes are left in place for six months to a year before falling out on their own. If they’re still there after three years, doctors usually remove them to minimize the risk of a permanent hole in the eardrum.
What Happens After Ear Tube Surgery?
The ear tube procedure is quick—usually 30 minutes or less under general anesthesia. Recovery is usually easy, too.
“Most kids can go swimming in a pool or take a bath the next day,” says Dr. Darrat. “The only restriction is swimming in a lake.” Lake water contains bacteria that can cause infections, so doctors usually recommend earplugs or a special headband to protect the ears.
Can You Prevent Ear Infections?
Ear infections are part of childhood for most kids, but you can help prevent them if you:
- Avoid secondhand smoke. Exposure to cigarette smoke increases the risk of ear infections.
- Keep sick kids home. If your child is sick, keeping them out of daycare helps prevent the spread of illness to other children.
- Practice good hygiene. Regular handwashing and cleaning toys can help reduce exposure to germs.
- Speak up about antibiotics. If your child’s antibiotic didn't work the first two times, tell your doctor. They can help determine whether your child needs a different medication.
When in Doubt, Get It Checked Out
If you're concerned about your child's recurrent ear infections, trust your instincts and consult with your pediatrician or an ENT specialist. “It's really important that once the tubes are in, you follow up with your ear, nose and throat doctor,” Dr. Darrat emphasizes. “We want to make sure the tubes are functioning well and that your child is comfortable and healthy.”
Reviewed by Ilaaf Darrat, M.D., a pediatric ear, nose and throat specialist who sees patients at Henry Ford West Bloomfield Hospital and Henry Ford Medical Center - Plymouth.
