When Ear Tubes Fall Out, What Happens Next?

Ear tubes are temporary. Most short term ear tubes naturally fall out within 6 to 18 months as the eardrum heals around them, with a mean extrusion time of approximately 14 months [1]. Once this happens, the Eustachian tube becomes responsible for ventilating the middle ear again.

For some children, the Eustachian tube has matured enough to keep the ear healthy on its own. For others, fluid and negative pressure can return. Research shows that between 20% and 29% of children experience OME recurrence after tube extrusion [1, 2]. Children whose tubes fall out earlier, before 12 months, are at substantially higher recurrence risk than those whose tubes stay in longer [1, 2].

This period after tube extrusion is one of the most important times to support Eustachian tube function.

Can Earflo Help Prevent a Second Set of Ear Tubes?

Yes, in many cases EarFlo may help support the middle ear during this transition period.

EarFlo is designed to help ventilate the middle ear by assisting the Eustachian tube to open during swallowing. This can help maintain healthy middle ear pressure and reduce the conditions that allow fluid to accumulate behind the eardrum.

Two peer reviewed EarFlo studies support this. In an initial feasibility study, 89% of children who were already indicated for ear tube surgery avoided surgery after four weeks of regular use, with 86% demonstrating middle ear pressure improvement on tympanometry [3]. A subsequent prospective cohort study in children as young as 2 years confirmed these findings with more rigorous reporting: mean hearing improvement of 12.9 dB HL (95% CI: 7.8 to 17.9) at two weeks, 91% of ears demonstrating at least initial tympanometric improvement, and 89% surgery avoidance, with 99% median objective adherence and no adverse events recorded [4].

And in a recently published randomized controlled trial of autoinflation started after tube extrusion, children who used autoinflation had a significantly lower reoperation rate (7.7%) compared to children who received observation only (28.6%) [5].

Why Ear Problems Sometimes Return After Tubes Fall Out

Ear tubes do not fix the underlying Eustachian tube dysfunction. Instead, they bypass it by allowing air to enter the middle ear directly through the eardrum [6].

While the tube is in place, the middle ear remains ventilated, pressure can equalize more easily, and fluid is less likely to build up. Once the tube falls out and the eardrum heals, the Eustachian tube must manage this process independently again.

If the Eustachian tube is still not functioning well, negative pressure and fluid can return. In children, the Eustachian tube is shorter, narrower, and more horizontal than in adults, making it more susceptible to dysfunction [7]. Most children’s Eustachian tubes mature and function normally by around age 7 [7], meaning the post extrusion period is most critical for younger children who still have years of development ahead.

Why the Period After Tube Extrusion Matters

The weeks and months after a tube falls out are often the highest risk period for recurrence, particularly when extrusion happens before 12 months [1, 2].

Rather than waiting for fluid and hearing problems to return, many families look for ways to proactively support the Eustachian tube during this transition. This is where EarFlo may help.

Regular use of EarFlo can support middle ear ventilation while the child’s Eustachian tube continues to mature naturally.

Different Ears Can Have Different Outcomes

It is common for children to have different situations in each ear after tubes. One ear may heal normally while the other continues to develop fluid. One eardrum may fully close while a small perforation remains in the other. One ear may maintain normal hearing while the other struggles with pressure problems.

Because of this, each ear should be considered separately.

If the Eardrum Has Healed and the Ear Is Clear

This is one of the best situations for using EarFlo. The tube is gone, the eardrum has healed, and there is currently no fluid. The main question is whether the Eustachian tube can continue keeping the middle ear healthy independently.

Regular EarFlo use may help support middle ear ventilation, maintain healthy pressure, reduce the chance of fluid returning, and assist the Eustachian tube while it matures.

If Fluid Has Returned and Another Tube Is Planned

If your child has developed fluid again and another surgery is already scheduled, it may still be worth trying EarFlo first.

Some families use EarFlo during the waiting period before surgery to see whether the middle ear improves enough to avoid another procedure. In two EarFlo clinical studies, most children initially indicated for surgery avoided ear tube placement after four weeks of regular use [3, 4].

Even if surgery still goes ahead, EarFlo may later be useful again after the next tube extrudes.

Can Earflo Be Used If There Is a Small Perforation?

A small persistent perforation in the eardrum does not necessarily prevent EarFlo use. EarFlo uses a precisely controlled, low pressure puff of air delivered during swallowing, a fundamentally different mechanism from forceful nose blowing, which is not recommended with a perforated eardrum.

However, if there is active ear discharge, pain, or infection, families should speak with their doctor before use.

How Earflo Works

EarFlo helps open the Eustachian tube using controlled pressure generated naturally during swallowing. When the Eustachian tube opens successfully, the middle ear can ventilate and pressure can equalize more normally.

Regular use may help ventilate the middle ear, equalize pressure, support fluid drainage, and reduce negative middle ear pressure.

For children whose Eustachian tube function is still developing, EarFlo may help bridge the gap after ear tubes extrude.

When Should You Start Using Earflo?

There is generally no need to wait until the tube has already fallen out. Some families begin using EarFlo while the tube is still in place to support the middle ear environment early. Others begin after extrusion once the Eustachian tube resumes responsibility for ventilation. In either situation, earlier and more consistent use may provide more benefit.

How Often Should Earflo Be Used?

EarFlo should be used consistently as directed, typically twice daily. The benefits of middle ear ventilation build over time with regular use rather than occasional sessions. Consistency is particularly important during the high risk period after tube extrusion.

Should Allergies and Nasal Congestion Also Be Treated?

Yes. Conditions such as allergic rhinitis and chronic nasal congestion can affect Eustachian tube function by increasing inflammation and narrowing the passage. Managing these underlying contributors, which may include nasal steroid sprays or antihistamines where appropriate, alongside EarFlo use may help create better conditions for healthy middle ear ventilation. Speak with your doctor about what is appropriate for your child.

The Bottom Line

When ear tubes fall out, the Eustachian tube must take over middle ear ventilation again. Between 20% and 29% of children experience OME recurrence after extrusion [1, 2], and the risk is higher when tubes fall out earlier. Most children’s Eustachian tubes mature fully by around age 7 [7], making the post extrusion years the most critical window.

EarFlo is designed to support middle ear ventilation during this important period. Whether your child’s tube has recently extruded, fluid has already returned, or another surgery is being considered, EarFlo may provide a proactive, non surgical option to help support healthy middle ear function at home.

Frequently Asked Questions

How long do ear tubes usually stay in?

Most short term ear tubes naturally fall out within 6 to 18 months, with an average of around 14 months [1].

Can fluid return after ear tubes fall out?

Yes. Research shows that OME returns in approximately 20% to 29% of children after tube extrusion [1, 2]. Children whose tubes fall out before 12 months are at higher risk.

Can Earflo be used before another ear tube surgery?

Some families choose to try EarFlo before a scheduled second surgery to see whether middle ear ventilation improves enough to avoid the procedure. In two EarFlo clinical studies, most children initially indicated for surgery avoided tube placement after four weeks of use [3, 4].

Can Earflo be used while tubes are still in place?

Yes. EarFlo can generally be used whether tubes are still present or have already extruded.

Can Earflo help if only one ear has problems?

Yes. It is common for one ear to recover differently from the other after tubes, and EarFlo can be used even when only one ear is of concern.

At what age do Eustachian tube problems usually resolve on their own?

Most children’s Eustachian tubes mature and function normally by around age 7 [7], though this varies by child.

References

[1] Alaraifi AK, Alkhaldi AS, Ababtain IS, Alsaab FA. Predictors of tympanostomy tube extrusion time in otitis media with effusion. Saudi Med J. 2022;43(7):730 736. doi:10.15537/smj.2022.43.7.20220156. PMC9749685. (Mean extrusion time 13.96 months across 258 ears; short term tubes extrude 6 to 18 months after placement; OME recurrence in 28.7% of ears; shorter extrusion time significantly associated with higher recurrence, p=0.002; tubes lasting more than 12 months had roughly half the recurrence rate of those extruded earlier.)

[2] Yaman H, Yilmaz S, Guclu E, Subasi B, Alkan N, Ozturk O. Otitis media with effusion: recurrence after tympanostomy tube extrusion. Int J Pediatr Otorhinolaryngol. 2010;74(3):271 274. doi:10.1016/j.ijporl.2009.11.035. PMID 20044147. (OME recurrence rate 20.7% across 91 children / 169 ears; recurrence higher when tube retention time was shorter; group with tubes under 6 months had 36.5% recurrence vs. 10.5% for tubes over 12 months.)

[3] Soto MJ, Hura N, Oldakowska I, Oldakowski M, Bumbak P, Santa Maria PL. Feasibility of a Novel Autoinflation Device to Treat Pediatric Otitis Media With Effusion At Home. OTO Open. 2025;9(2):e70128. doi:10.1002/oto2.70128. PMID 40370996. (n=21 enrolled, 18 analyzed; single arm cohort; 89% avoided tympanostomy tube placement; 86% demonstrated middle ear pressure improvement on tympanometry.)

[4] Santa Maria PL, Hura N, Lalwani Z, Oldakowska I, Oldakowski M, Bumbak P, Soto MJ. A Novel Autoinflation Device for Persistent Pediatric Otitis Media with Effusion: A Prospective Single-Arm Cohort Study. Am J Otolaryngol. 2026. In press. Manuscript YAJOT-D-26-00200R1. (n=18; prospective cohort in children aged 2 to 12 years; 99% median objective adherence; mean PTA improvement 12.9 dB HL (95% CI: 7.8 to 17.9) at 2 weeks and 9.7 dB HL (95% CI: 3.7 to 15.7) at 4 weeks; 91% of ears with at least initial tympanometric improvement; 89% surgery avoidance; no adverse events.)

[5] Na HS, Lee S, Kim S, Lee HM, Oh SJ, Lee IW, Choi SW. Autoinflation After Tympanostomy Tube Extrusion in Otitis Media With Effusion: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2026;152(5):472 478. doi:10.1001/jamaoto.2026.0044. Published online March 12, 2026. (n=54; autoinflation group: 19.2% recurrence, 7.7% reoperation rate; observation group: 35.7% recurrence, 28.6% reoperation rate; reoperation difference statistically significant; tympanometry more stable in autoinflation group.)

[6] Bhatt JM, Mahboubi H. Eustachian Tube Dysfunction. StatPearls. NCBI Bookshelf. Updated February 2023. NBK555908. (Tympanostomy tubes bypass but do not treat underlying ETD; 2017 IFOS consensus statement identifies autoinflation as the only nonsurgical intervention with evidence of effectiveness for ETD.)

[7] Bhatt JM, Mahboubi H. Eustachian Tube Dysfunction. StatPearls. NCBI Bookshelf. Updated February 2023. NBK555908. (Pediatric ETD generally improves with Eustachian tube maturation, usually occurring around age 7; children’s tubes are shorter, narrower, and more horizontal than adults.)

This article is for informational and educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider regarding your child’s specific situation.

Disclosure: Dr. Peter Santa Maria is a co inventor of EarFlo and holds equity in the company.