How long after ear tubes will hearing improve in adults

Created: July 3, 2008; Last Update: May 9, 2019; Next update: 2022.

Treating chronic glue ear using ear tubes can temporarily improve hearing somewhat because they clear out the middle ear. Hearing also improves after about six months in children who don't have treatment with ear tubes.

Children often get colds, and it's not uncommon for their ears to be affected too. Infections in the nose or throat area can easily spread to the middle ear, particularly in young children. Directly behind the eardrum there is a space in the middle ear called the tympanic cavity. This small space is usually filled with air which sound waves travel through to reach the inner ear. If a middle ear infection causes the mucous membranes to swell up and secrete fluid, the tympanic cavity fills up with the fluid. This is called otitis media with effusion or "glue ear." Sometimes the canal leading from the middle ear to the throat (the Eustachian tube) becomes blocked too.

If the fluid can't escape, it builds up behind the eardrum and the child can't hear properly. Glue ear usually goes away after a few days or weeks, If it doesn't, the resulting poor hearing can delay speech and language development in children.

When a child has persistent glue ear, doctors usually recommend waiting a few months to see if it clears up on its own. They can check the child's ears regularly in the meantime. If the glue ear does not clear up, a minor surgical procedure called paracentesis may be considered. This involves puncturing the eardrum. Then the fluid can drain out, or it is removed using suction.

If fluid still keeps on building up in the child’s ear and he or she can't hear properly, ear tubes are often recommended. These thin plastic or metal tubes are placed in the middle ear through the cut (incision) in the eardrum so that the middle ear is better ventilated. They aim to help glue ear get better, improve hearing and prevent delayed speech and language development. Ear tubes are normally inserted while the child is under general anesthetic, and they usually fall out on their own after about 6 to 18 months. The incision in the eardrum closes on its own too.

Because there is some disagreement about the benefit of ear tubes, researchers from the Cochrane Collaboration – an international research network – looked for randomized controlled trials in this area. In this kind of study the participants are randomly divided into two or more treatment groups. At the end of the study, the groups are compared to see the effects of the different treatments. When looking at the treatment of chronic glue ear in children, this means that one group of children is given ear tubes while the other group either has no treatment or they only have their eardrum punctured (paracentesis).

The researchers found ten studies involving more than 1,700 children with chronic glue ear. After analyzing these studies, they concluded that the use of ear tubes can somewhat improve hearing within the first nine months. After one year there were no longer any differences between the groups. The children could hear equally well, regardless of whether they had received ear tubes or not. No influence on speech and language development was found.

The ear tubes also had side effects: They led to increased mucous discharge from the ear, particularly in children under the age of three. About one third of the children with ear tubes had scarring of the eardrum, which may slightly affect their hearing.

Because ear tubes have only limited effectiveness, it's often a good idea to not have surgery after just three months, but to wait under close medical supervision. Ear tubes may still be an option if the glue ear has not gone away on its own within six months. This watchful waiting treatment approach is probably just as effective as early surgery over the long term.

It can't be ruled out that some children will benefit more than others from treatment with ear tubes. Like any operation, though, the insertion of ear tubes is associated with certain risks, such as damage to the eardrum or scarring. More research is needed to be more confident about when the short-term advantages of ear tubes are worth the risks associated with surgery.

Sources

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Ear infections happen when a bacteria or virus affects the middle ear. The result is constant inflammation and fluid buildup in the ear. Although children get more frequent ear infections, adults are not exempt. There is a small subset of adults that get ear infections every year. As such, these adults may also need ear tubes, which may be inserted through a myringotomy.

So what are ear tubes anyway? Ear tubes are tiny cylinders usually made of plastic or metal. These tubes get surgically implanted into the eardrum for a short period. A doctor inserts an ear tube to provide a vent in the middle ear. This vent prevents fluids from accumulating behind the eardrum. Ear tubes are also called tympanostomy tubes, ventilation tubes, myringotomy tubes, and pressure equalization tubes.

Why would you need an ear tube in the first place?

Most ear infections respond well to non-surgical treatment. A doctor will first prescribe antibiotics, antihistamines, or nasal steroids. These clear up the inflammation for adults and kids alike. However, there are a few reasons why these fail, and ear tubes are necessary:

• Fluid may be trapped behind the eardrum and may cause inflammation. It may also build up in the middle ear that may lead to viral or bacterial infection.
• A middle ear infection may result in hearing loss. Infections can cause speech development delays, communication and behavioral problems, and poor school performance in children.
• After 3 or more episodes in 6 months or 4 or more in a year, ear tubes may help.
• Chronic middle ear infections do not improve despite antibiotic treatment.
• Chronic suppurative otitis media is a persistent ear infection that may lead to tearing or perforation of the eardrum.

Time for a myringotomy

Myringotomy is one of the possible treatments for an ear infection if the patient does not respond to the medical treatments. This procedure can also acquire sample fluid from the middle ear or place ear tubes. Looking through a microscope, the doctor makes a tiny incision in the eardrum. Then, the doctor drains any trapped fluid from the middle ear. Afterward, the ear tube will be inserted and left in place. Myringotomies are minimally invasive and last about 20 minutes, meaning the patient can go home soon afterward.

What to expect after surgery

Once the tubes are inserted, the patient may feel some popping, pulsation, or clicking in the ear. There will also be some minor pain, especially when burping, chewing, or yawning. The fluid will slowly run out as the days progress, and some patients see a clear discharge on the ear. The doctor doesn’t need to close the incision as the ear heals around the tube. By then, the tubes will fall out naturally. If the tubes fall out prematurely, immediately contact the physician.

Protection through ear tubes

Adults may be greater impacted by ear infections since the condition may affect the quality of life. If the medicine fails, myringotomy is best. These tiny tubes have a secondary function. The ventilation provided by ear tubes keeps the air in the middle ear refreshed. Tubes also equalize the pressure inside the ear with the air pressure outside the body and provide drainage that prevents fluid buildup in the ear. If the air is causing pain and discomfort at any age, speak with a doctor immediately.

Ear tubes are recommended when an individual suffers repeated ear infections of the middle ear, loses hearing due to fluid in the middle ear, or is off-balance due to fluid in the middle ear. When in place, ear tubes are effective at holding open an incision in the eardrum, allowing drainage of the affected middle ears and preventing the accumulation of fluid and infection in the middle ear space. This helps reduce the risk for ear infection in the future, restores hearing, improves balance, resolves speech problems, and improves sleep and behavior issues brought on by chronic ear infections.

While an occasional viral ear infection will resolve without treatment and bacterial infections are often treated and cured with antibiotics, ear infections aren’t always easy to overcome. When the infections continue to arise time and again, more aggressive action must be taken in order to prevent an array of potential health and hearing problems. In many cases, that action is placing ear tubes in the ears of the affected individual.

Why Consider Ear Tubes?

Reasons a child or adult may need ear tubes include the following:

• Frequent middle ear infection. Beneath the eardrum, there is an open area (the middle ear) that is home to tiny vibrating ear bones. When a bacterial or viral infection settles in there, the result is sudden inflammation and pain.

• Hearing loss related to middle ear fluid. Frequent middle ear infections, allergies and other conditions can cause fluid to form and stay in the middle ear for a prolonged period. Eventually, this fluid can result in hearing loss.

• Dizziness related to middle ear fluid. Fluid in the ear can cause dizziness and is a readily treatable cause of dizziness. In young children, this dizziness may appear as lack of coordination.

• Tinnitus related to middle ear fluid. Fluid in the ear can cause tinnitus, or extra sounds in the ears. This can sound like your pulse, or like ringing or a seashell. This is a treatable cause of tinnitus.

What to Expect with Ear Tube Placement

Prior to receiving ear tubes, the affected individual undergoes tests to ensure the tubes will effectively treat his or her symptoms. Should the individual no longer respond properly to antibiotics or be at risk for hearing loss due to chronic ear infections, ear tubes are a good option. Tubes are very efficient at draining fluid from the middle ear, and may be the only way to completely remove fluid that has been present in the middle ear for many months.

Installing ear tubes is a relatively simple procedure that normally takes less than half an hour. During the procedure, a small incision is made in the eardrum by the surgeon with a tiny scalpel. The surgeon then locates and removes any fluid residing in the inner ear using a suction device. Once the fluid is removed, the ear tube is inserted into the hole made by the surgeon.

While the ear tube will stay in the patient’s ear for at least several months, the patient will typically regain any lost hearing due to fluid build-up immediately and can return to activities of daily living within 24 hours. Over the course of time, the ear tube normally falls out without assistance and the surgical hole made by the surgeon closes on its own. Should the ear tubes fall out earlier than that, new tubes may need to be installed to ensure the treatment provides long-term benefits. In extreme cases of frequent fluid in the middle ear, the otolaryngologist may additionally encourage the removal of adenoid tissue if it is enlarged, as this can increase the success rate of ear tubes.

Why Temple Health for Ear Tubes?

In the event an individual’s recurrent ear infection causes significant speech or hearing issues, the multidisciplinary team at Temple Head & Neck Institute is ready to help.

Leading the region and nation in ear tubes and other associated services, the specialists at the Temple Head & Neck Institute give patients access to the most advanced diagnostic and therapeutic methods as recommended by current research.

Temple Health’s multidisciplinary team of specialists collaborates to manage ear infections and any potential hearing loss that accompanies it. Because of our understanding of the potential life-long problems associated with these issues, our team provides a tailored approach to treatment for each patient.

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Find a doctor near you, request an appointment, or call 800-TEMPLE-MED (800-836-7536) today.