Standard ear tubes stay in the eardrum for about 8 to 15 months before falling out on their own. Long-term tubes last longer, typically 15 months to two years. The exact timeline depends on the type of tube placed, your age, and how your body responds to it.
Short-Term vs. Long-Term Tubes
Most people (especially children) receive short-term tubes, which are small, spool-shaped devices designed to stay in the eardrum for 8 to 15 months. These tubes have a small flange on the outer side. Over time, skin cells naturally build up behind that flange and gradually push the tube out of the eardrum and into the ear canal. This process is called extrusion, and it happens without you feeling it.
Long-term tubes have a different design. They lack that outer flange, which means skin cells don’t accumulate behind them the same way. That’s what allows them to stay in place for 15 months to two years or more. These are typically reserved for people who need ventilation for a longer period, such as those with recurrent infections that kept coming back after short-term tubes fell out.
What Happens When a Tube Falls Out
When a tube extrudes, it slides into the ear canal and eventually works its way out, sometimes landing on a pillow or going unnoticed entirely. Many parents discover a tube has fallen out only at a routine checkup. You typically won’t feel pain or hear a pop. The tiny hole left in the eardrum usually closes on its own within a few weeks.
In rare cases, a tube falls inward into the middle ear space instead of outward into the canal. When that happens, a minor procedure is needed to retrieve it through a small incision in the eardrum.
When Tubes Stay Too Long
Tubes that remain in the eardrum beyond two years are considered retained. Research published in JAMA Otolaryngology found that once a tube has been in place for two years, the odds of it falling out on its own are essentially zero. At that point, surgical removal becomes the standard recommendation.
The longer a tube stays past the two-year mark, the higher the risk of complications. In one study, tubes retained for two to three years caused eardrum perforation in about 5% of cases. That number jumped dramatically with time: tubes left in for four to five years led to perforation in 25 to 50% of cases, and those retained beyond five years caused perforation in nearly every younger child studied and about 43% of older children. Drainage and the growth of granulation tissue (a type of inflammatory tissue) followed a similar pattern, becoming far more common the longer the tube stayed.
Older children, those seven and up, tend to have higher complication rates from retained tubes than younger children. In the same study, overall perforation rates were about 27% in the older group compared to 6% in younger children.
Surgical Removal
The most common reason a tube is surgically removed is simply that it has been in too long, accounting for roughly 61% of removal procedures. Other reasons include persistent drainage or infection (about 22%), a blocked tube, or a tube that has shifted out of position.
The good news is that eardrum healing after surgical removal is very reliable. About 87% of eardrums close completely after a tube is taken out, regardless of how long the tube was in place, the patient’s age, or why the tube was removed. When the reason for removal was drainage or infection, the closure rate was even higher, around 93%.
Follow-Up Appointments to Expect
The American Academy of Otolaryngology recommends a first follow-up visit within three months of tube placement to confirm the tubes are in the right position and working properly. After that, expect visits roughly every six months for as long as the tubes are in place. These checkups allow your ENT to monitor whether the tubes are still functioning, whether fluid is building up again, and whether the tubes are starting to extrude. Keeping these appointments is especially important because many complications from retained tubes develop gradually and without obvious symptoms.
Do Some People Need a Second Set?
Some children outgrow their ear problems by the time their first set of tubes falls out, typically between ages 2 and 4. Others continue to get frequent ear infections or fluid buildup after extrusion and need a second set. The decision depends on whether symptoms return after the tubes come out. Second sets are common and follow the same timeline: another 8 to 15 months for short-term tubes, longer for long-term ones. Children who need a second or third set are more likely to receive long-term tubes to extend the period of ventilation.