Most ear tubes do not need to be removed. They fall out on their own as the eardrum naturally pushes them outward, typically within about 9 months of placement. In some cases, though, a tube stays lodged longer than expected, and an ENT may recommend removing it to prevent complications.
How Tubes Fall Out on Their Own
The eardrum is living tissue that continuously grows and migrates outward, much like skin healing over a wound. This slow movement gradually nudges the tube out of the small slit where it was placed. The average extrusion time is about 9 months (254 days), though the range is wide: some tubes come out in as little as two weeks, while others stay put for over two years. Most parents never notice when it happens. The tiny tube simply falls into the ear canal and either drops out or gets caught in earwax.
Once the tube is out, the small hole in the eardrum usually closes on its own within a few weeks. No special care is needed during this process.
Short-Term vs. Long-Term Tubes
The type of tube matters. The most common style, sometimes called a grommet, is a small spool-shaped tube designed for short-term use. These are the ones that typically fall out within a year. Some children who keep getting ear infections after grommets fall out end up needing a second or third set.
Long-term tubes, often called T-tubes because of their shape, are designed to stay in place for years. They’re used when a child has had multiple failed sets of grommets or has an underlying condition like cleft palate that causes persistent drainage problems. T-tubes almost always require intentional removal by an ENT because they anchor more firmly into the eardrum and rarely come out on their own.
When Removal Becomes Necessary
If a standard tube hasn’t fallen out after two to three years, most ENTs will discuss removing it. The longer a tube stays in, the higher the risk of problems. A study published in JAMA Otolaryngology tracked complication rates by how long tubes were retained:
- 2 to 3 years of retention: ear drainage in 10.3% of patients, granulation tissue (irritated, overgrown tissue around the tube) in 13.8%, and a permanent eardrum hole in 5.2%.
- More than 5 years of retention: drainage in 40%, granulation tissue in 40%, and a permanent hole in nearly 47%.
That jump is significant. A tube that’s been sitting quietly for two years has a relatively low risk profile, but one that lingers beyond five years causes problems in almost half of cases.
The most common reason for surgical removal is simply that the tube has been in too long, accounting for about 61% of removal procedures. Other reasons include persistent ear drainage or recurring infections (about 22%), the tube becoming blocked (7%), or the tube slipping inward into the middle ear space (6%).
What the Removal Procedure Looks Like
For adults and cooperative older children, tube removal is a quick office procedure. The ENT uses a microscope and a small instrument to grasp and pull the tube out of the eardrum. It takes only a few minutes, and most people describe it as uncomfortable but not painful.
Young children who can’t hold still typically need brief general anesthesia, making it a short outpatient surgery. The actual removal takes only moments, but the preparation and recovery from anesthesia add time to the visit.
Does the Eardrum Close After Removal?
In most cases, yes. When tubes are removed because they’ve stayed in too long, about 87% of eardrums heal closed on their own. When the reason for removal is infection or drainage, the closure rate is even higher, around 93%.
For the small percentage of eardrums that don’t close naturally, a minor repair procedure can help. The ENT places a tiny paper or gel patch over the hole during or shortly after removal, which acts as a scaffold for the eardrum to grow across. With a patch, success rates range from about 87% to 96%, depending on the technique used. Without a patch, about 74% still heal, but patching meaningfully improves the odds.
If the hole persists even after patching, a more formal eardrum repair called a tympanoplasty may be needed. Recovery from that surgery takes a few days to several weeks, with hearing gradually improving over about two months as the eardrum fully heals.
Signs a Retained Tube May Need Attention
If your child still has tubes after the one-year mark, your ENT will likely monitor them at regular checkups. Between visits, watch for persistent or foul-smelling drainage from the ear, which can signal infection or granulation tissue forming around the tube. Increasing ear pain, noticeable hearing changes, or a feeling of fullness in the ear are also worth reporting. None of these necessarily mean the tube must come out immediately, but they help your ENT decide whether watchful waiting is still the right approach or whether it’s time to intervene.