The appearance of fluid draining from the ear after the placement of ear tubes can be alarming. Tympanostomy tubes, often called ear tubes, are tiny ventilation devices inserted into the eardrum to treat chronic ear issues. Their primary function is to equalize pressure and provide a channel for trapped fluid to exit the middle ear space. This procedure allows the middle ear to ventilate properly, preventing fluid accumulation that causes recurrent infections and hearing difficulties.
Understanding Drainage After Tube Placement
Drainage from the ear canal is a common and expected occurrence following the insertion of tympanostomy tubes. This fluid drainage is frequently a sign that the tube is working correctly by removing residual fluid trapped behind the eardrum before surgery. The fluid, known as otorrhea, is now able to flow out, relieving pressure and allowing the middle ear to heal.
The timing of the drainage offers clues about its cause. Immediate postoperative drainage, typically seen in the first few days, is usually the direct result of the surgery and the evacuation of old fluid. Drainage that appears weeks or months later, however, almost always indicates a new middle ear infection (otitis media). With a tube in place, the infection-related fluid drains out through the tube rather than building up and causing pain.
The presence of drainage means the tube is patent, or open, and performing its intended role as a drain by bypassing the eardrum. This allows infectious material to escape, which is a major advantage of the procedure.
Characteristics of Ear Drainage
The visual characteristics of the drainage help in understanding what is happening inside the ear.
Postoperative Drainage
Drainage that appears clear, thin, or slightly yellowish is common immediately after surgery as the middle ear clears old, non-infected fluid. This fluid is often residual effusion that was causing hearing impairment before the tube placement.
Infection-Related Drainage
Cloudy, thick, or pus-like drainage (yellow, green, or white) typically signals a new middle ear infection. Since the tube drains this infected material, the infection can often be treated directly with ear drops rather than systemic oral antibiotics.
Bloody or Foul Drainage
Pink-tinged or bloody drainage is most common in the first day or two following the tube insertion, resulting from the small incision made in the eardrum. Later bloody drainage is usually due to irritation around the tube site or minor granulation tissue. Foul-smelling drainage, regardless of color, is a strong indicator of an active bacterial infection and warrants starting the prescribed antibiotic ear drops.
Managing Drainage at Home
When drainage occurs, the focus shifts to keeping the outer ear clean and applying topical medication as directed. Gently clean the outside of the ear and surrounding skin with a soft cloth and mild soap to remove excess fluid and prevent skin irritation. Avoid inserting cotton swabs into the ear canal, as this can push drainage back in or cause irritation.
Applying Medication
For drainage related to infection, the primary treatment is usually prescription antibiotic ear drops, which deliver medication directly to the middle ear through the tube. To ensure the drops reach the middle ear, the patient should lie on their side. The small flap of cartilage in front of the ear canal, called the tragus, should be gently pressed a few times after instilling the drops. This technique, known as the tragal pump, helps move the medication past the tube and into the middle ear space.
Water Precautions
While drainage is occurring, water precautions may need to be temporarily increased to prevent external contaminants. During an active draining episode, use earplugs or petroleum-coated cotton balls to keep the ear canal dry during bathing and water activities. Once drainage has stopped, the usual water precautions, typically allowing surface swimming, can be resumed.
Warning Signs That Require Medical Attention
While drainage is often managed at home, certain signs indicate the need for professional medical intervention.
Persistent Drainage
Persistent drainage that continues for more than five to seven days, even with prescribed antibiotic ear drops, suggests the infection is not resolving. This requires a follow-up with the specialist, who may need to suction the ear canal to clear debris or adjust the medication.
Acute Symptoms
A sudden increase in pain after drainage has begun or an unexplained, high fever (especially above 102°F) are signs of a potentially more serious issue. Pain not easily relieved with over-the-counter medication should be immediately reported. Swelling or redness behind the ear also signals a complication and requires urgent evaluation.
Abrupt Cessation
Another warning sign is when drainage suddenly stops, especially if followed by the return of ear pain. This abrupt cessation can indicate that the tube has become blocked by thick fluid or crusting. In these cases, the tube may need to be cleared by a specialist to restore its function.