Ear infections in children:
when do kids need ear tubes?

Ear infections are the number one reason children in the United States visit the doctor — and one of the leading reasons they receive antibiotics. For most children, an occasional ear infection resolves on its own or with a short course of antibiotics. But for others, infections keep coming back — disrupting sleep, causing pain, affecting hearing, and impacting speech and language development.

If your child has had three or more ear infections in six months, or four or more in a year, it may be time to see a pediatric ENT specialist. At Seaside ENT in Brooklyn and Staten Island, Dr. Ruwaa Samarrai evaluates children with recurrent ear infections and helps families understand all of their options — from watchful waiting to ear tube surgery.

What causes ear infections in children?

The middle ear — the space behind the eardrum — is connected to the back of the throat by a small channel called the Eustachian tube. This tube helps drain fluid from the middle ear and equalize pressure. In young children, the Eustachian tube is shorter, more horizontal, and floppier than in adults, making it much easier for bacteria and viruses to travel from the throat into the middle ear.

When a child gets a cold or upper respiratory infection, the Eustachian tube can become swollen and blocked. Fluid builds up behind the eardrum and becomes infected, causing the pain, fever, and fussiness parents recognize as an ear infection (medically called acute otitis media).

Some children are simply more prone to this cycle than others — due to anatomy, daycare exposure, allergies, or secondhand smoke exposure. For these children, repeated infections are not a sign of bad parenting or poor hygiene. They reflect an anatomical vulnerability that often improves with age — but sometimes needs treatment in the meantime.

Signs your child may have an ear infection

When should my child see a pediatric ENT specialist?

Your child's pediatrician is usually the first stop for ear infections, and rightly so. But a referral to a pediatric ENT is appropriate when:

• Your child has had 3 or more ear infections in 6 months
• Your child has had 4 or more ear infections in 12 months
• Fluid has been present behind the eardrum for 3 months or longer
• There are signs of hearing loss or speech/language delay
• Ear infections are not responding to multiple courses of antibiotics
• Your child has had a ruptured eardrum

What are ear tubes — and how do they work?

Ear tubes (called tympanostomy tubes or pressure equalization tubes) are tiny cylinders — about the size of a sesame seed — that are surgically placed through a small incision in the eardrum. The procedure is called a myringotomy with tympanostomy tube placement.

The tubes serve two purposes: they allow fluid to drain out of the middle ear, and they allow air to enter, restoring normal pressure and preventing the fluid buildup that leads to recurrent infections.

What does the ear tube procedure involve?

In-office ear tubes with no general anesthesia — TULA

At Seaside ENT, we are proud to offer TULA (Tube Under Local Anesthesia) — an innovative approach to ear tube placement that can be performed right in our office, without general anesthesia. This is a significant advancement for families who are anxious about putting their child under, or for older children and adults who want to avoid the risks and recovery associated with general anesthesia.

How does TULA work?

TULA uses a topical anesthetic applied directly to the eardrum to numb the area before tube placement. A small incision is made and the tube is inserted — the same way it would be in an operating room, just without the need for sedation. The entire procedure typically takes just a few minutes per ear.

Who is a good candidate for TULA?

• Older children (generally school-age and up) who can cooperate during the procedure
• Adults with recurrent ear infections or chronic fluid
• Patients or families who want to avoid general anesthesia
• Patients who need a repeat tube after a previous set has fallen out
• Patients with underlying health conditions that make anesthesia higher risk

For younger children or those who may have difficulty staying still, traditional ear tube placement under brief general anesthesia remains the safest and most effective option. Dr. Samarrai will discuss which approach is right for your child or family member at your consultation.

Are ear tubes safe?

Ear tube surgery is one of the most commonly performed procedures in pediatric medicine, and it has an excellent safety record. Complications are uncommon. Dr. Samarrai completed a subspecialty fellowship in Pediatric Otolaryngology at Connecticut Children's Medical Center and has extensive experience evaluating children for this procedure.

Not every child with recurrent ear infections needs tubes. Dr. Samarrai takes a conservative, individualized approach — weighing the frequency and severity of infections, the child's age, hearing status, and developmental milestones before making any recommendation.

Pediatric ENT care in Brooklyn & Staten Island

Seaside ENT offers pediatric ENT evaluations at our Brooklyn office at 6818 3rd Ave, Brooklyn, NY 11220 (Bay Ridge) and our Staten Island office at 1191 Forest Ave, Staten Island, NY 10310. Dr. Samarrai sees patients in both English and Arabic, making our practice particularly accessible to the diverse families of Bay Ridge, Sunset Park, and surrounding communities.

We accept most major insurance plans including Medicaid and are actively credentialing with additional insurers. Call our office and we will help you understand your coverage options.