Conditions: Post-Tympanostomy Tube Otorrhea
General information on ear drainage after ear tube placement, including causes, treatment approaches, water precautions, and possible complications.
WHAT IT IS
Ear tubes (also called tympanostomy tubes, ventilation tubes, or grommets) are tiny tubes placed through the eardrum to let air into the middle ear and allow fluid to drain. Ear tube surgery is one of the most common operations performed in children, though tubes are sometimes used in adults as well.
Ear drainage through a tube, known medically as otorrhea, is the most common thing that happens after tubes are placed. It occurs at some point in roughly a quarter to a half of children with tubes, and sometimes more. The drainage is usually a sign that fluid from a middle ear infection is passing out through the tube rather than building up behind the eardrum. In that sense, some clinicians describe it as the "runny ear" version of a runny nose.
Drainage is often grouped by when and how often it happens:
Early drainage occurs within the first few weeks after surgery.
Delayed drainage occurs weeks or more after surgery, often with a cold or ear infection.
Recurrent drainage refers to several separate episodes over time (uncommon, affecting a small percentage of people).
Chronic drainage refers to discharge that lasts three months or longer (also uncommon).
CAUSES
Most drainage happens because of a middle ear infection, the same kind of infection the tubes were meant to help manage. Instead of the eardrum bulging or bursting, the infected fluid simply flows out through the open tube. Tubes are commonly used for recurrent ear infections and for persistent fluid behind the eardrum.
Common contributors include:
Colds and other upper respiratory infections, which frequently trigger episodes.
Bacteria normally involved in ear infections, and in some cases bacteria found in the environment or in water.
Viruses, which often occur alongside bacteria, especially in young children.
Biofilm, a thin coating of germs that can form on the tube itself and may play a role when drainage keeps coming back or becomes long-lasting.
Younger age, having tubes placed because of repeated ear infections, recent colds, and having older siblings are among the factors linked to a higher chance of drainage.
SYMPTOMS
The discharge may be watery, thick, cloudy, or discolored, and can sometimes have a bad smell. It may be blood-tinged, which by itself is generally not considered a cause for alarm.
Drainage can be the only symptom, or it can come with:
Ear pain or discomfort
Fever
Signs of a cold or congestion
Reduced hearing on the affected side
Many episodes are brief and relatively painless, but discharge that lasts several days can affect comfort, sleep, and daily quality of life.
EVALUATION
A clinician typically reviews the history of the drainage, including how it looks, how long it has lasted, and whether there has been pain, fever, or a recent cold, and examines the ear to check the tube and eardrum.
In episodes that keep returning, do not clear, or last a long time, a sample of the drainage is sometimes sent to a laboratory (a culture) to identify the specific germs involved and guide which medication is likely to work. Certain resistant bacteria are more likely in drainage that is recurrent or does not respond to usual treatment. When hearing is a concern, hearing testing (audiometry) may also be part of the evaluation.
TREATMENT
Antibiotic ear drops are widely regarded as the standard first-line treatment for uncomplicated drainage from ear tubes. Studies have generally found ear drops to be as effective as, or more effective than, antibiotics taken by mouth, while avoiding the whole-body side effects of oral medicines. Combination drops that contain both an antibiotic and a steroid (to reduce inflammation) have been found in some studies to work better than antibiotic drops alone. More information is available on the page about ear infection treatments.
Only ear drops that are approved for use with tubes or a non-intact eardrum are used, because certain older types of drops can potentially harm hearing when they reach the middle ear. This is why particular families of drops are typically chosen for people with tubes.
Because many episodes are mild and can settle on their own, brief observation is sometimes considered a reasonable option in select cases.
Antibiotics taken by mouth are generally reserved for specific situations rather than routine drainage, such as:
A high fever
Infection of the skin spreading beyond the ear canal onto the outer ear or nearby skin
Another infection that already needs oral antibiotics (for example, strep throat or a bacterial sinus infection)
Drainage that does not improve with ear drops
For persistent or repeated drainage, treatment guided by a culture result may be used, and an ear specialist may become involved.
PREVENTION AND WATER PRECAUTIONS
For most people with ear tubes, routine water precautions, such as earplugs, headbands, or avoiding swimming, are generally considered unnecessary. Research has not shown that these measures meaningfully prevent drainage for the average person, and surface swimming and shallow diving are unlikely to push water through the tube into the middle ear. Avoiding water can also be an inconvenience and may interfere with children learning to swim safely.
Water precautions may still make sense in certain circumstances, such as:
During an active episode of drainage
For someone who tends to get drainage repeatedly
When water causes discomfort during swimming, diving, or hair washing
Factors that may lower the chance of drainage overall include appropriate treatment of colds and ear infections and adherence to the surgical team's after-care instructions. Some drainage cannot be prevented and is simply part of how tubes work.
POSSIBLE COMPLICATIONS
Most drainage is short-lived and resolves without lasting problems. Less commonly, issues can include:
Recurrent or long-lasting (chronic) drainage, which may be associated with reduced hearing and can be linked to a blocked tube, extra tissue (granulation tissue) in the ear, or a tube that needs to be removed.
A tube that comes out early or becomes blocked.
A hole in the eardrum that does not close after the tube comes out, which is more likely with long-term tubes than short-term tubes (see tympanic membrane perforation).
Cholesteatoma, a rare skin growth in the middle ear.
Drainage that lasts a long time, keeps returning, is accompanied by significant pain or high fever, or is associated with hearing loss is generally evaluated by a physician, as it can occasionally point to an underlying problem that needs specialist attention.