Is clear drainage normal in a child with myringotomy (ear) tubes and an ear infection?

Clear Drainage with Myringotomy Tubes During Ear Infection

Yes, clear drainage from the ear is completely normal and expected when a child with myringotomy tubes has an ear infection—the drainage actually indicates the tube is functioning properly by allowing infected fluid to escape from the middle ear. 1

Understanding the Drainage

Ear drainage can vary in appearance and all types are normal:

• Drainage may be clear, cloudy, or even bloody—none of these presentations pose any danger to hearing 1
• The presence of drainage demonstrates that the tube is working correctly to drain infection from the middle ear space 1
• Most children do not experience pain or fever when an ear infection occurs with a functioning tube in place 1

This is fundamentally different from ear infections without tubes, where fluid becomes trapped behind the eardrum causing pressure and pain. The tube bypasses this problem entirely.

Recommended Treatment Approach

When visible drainage is present, the American Academy of Otolaryngology-Head and Neck Surgery recommends topical antibiotic ear drops as the best treatment:

• Use ofloxacin or ciprofloxacin-dexamethasone drops placed in the ear canal twice daily for up to 10 days 1, 2
• After instilling drops, "pump" the tragus (flap of skin in front of the ear canal) several times to help drops enter through the tube 1, 2
• Topical therapy achieves 77-96% clinical cure rates compared to only 30-67% with oral antibiotics 1, 2
• The superior efficacy results from increased drug concentration at the infection site and better coverage of likely pathogens (Pseudomonas aeruginosa and Staphylococcus aureus) 1

Oral antibiotics are unnecessary for most ear infections with tubes unless the child is very ill, has another concurrent infection requiring antibiotics, or the infection doesn't resolve after using ear drops 1

Practical Management Steps

For drainage management:

• Remove dried or built-up drainage at the ear canal opening using a cotton-tipped swab dipped in hydrogen peroxide or warm water, a cotton ball to absorb drainage, or gentle suction with an infant nasal aspirator 1, 2
• Prevent water entry during bathing or hair washing by using cotton saturated with Vaseline to cover the opening 1
• No swimming until drainage completely stops 1, 2
• Avoid using antibiotic ear drops for more than 10 days at a time to prevent yeast infections of the ear canal 1

When to Seek Further Evaluation

Call the otolaryngologist if:

• Ear drainage continues for more than 7 days despite appropriate treatment 1, 2
• Drainage from the ears occurs frequently 1
• The child has hearing loss, continued ear infections, or persistent ear pain/discomfort 1
• The primary doctor cannot visualize the tube in the ear 1

The 7-day threshold is critical—drainage persisting beyond this timeframe indicates treatment failure and requires reassessment rather than simply continuing the same therapy 2.

Common Pitfall to Avoid

A common mistake is assuming clear drainage means "no infection" or that only purulent (thick, colored) drainage requires treatment. Any visible drainage from the ear canal in a child with tubes during an infection episode is an indication for topical antibiotic therapy, regardless of the drainage's appearance 1, 2. The clear appearance simply reflects the stage or type of infection, not its absence.