Spontaneous Tympanostomy Tube Extrusion
The term for when an ear tube is starting to come out on its own is "spontaneous tube extrusion" or simply "tube extrusion." This is the expected, normal endpoint of tympanostomy tube function, not a complication 1.
What Tube Extrusion Means
Spontaneous extrusion is the natural process by which the tympanostomy tube is pushed out of the tympanic membrane as the eardrum heals and migrates laterally, eventually expelling the tube into the ear canal 1.
This is the intended outcome for short-term tubes, which are designed to remain in place for approximately 8-18 months before naturally extruding 2, 3.
The timing varies by tube type: Short-term tubes typically extrude within 6-18 months, while long-term tubes are designed to remain for 2+ years 2, 3.
Expected Timeline for Extrusion
93.1% of short-term tubes extrude spontaneously within 1 year, and 99.9% extrude within 2 years 4.
The mean extrusion time for standard short-term tubes (such as Paparella Type 1) is approximately 7.16 months 4.
Premature extrusion (occurring before adequate ventilation is achieved) occurs in approximately 7.7% of cases and is more common in children with recurrent acute otitis media compared to those with chronic otitis media with effusion 1, 4.
Distinguishing Normal from Abnormal Extrusion
Normal spontaneous extrusion occurs when:
- The tube is found in the ear canal or has fallen out completely 1
- The tympanic membrane heals closed behind it without perforation 1
- The timing is within the expected 6-18 month window for short-term tubes 2, 3
Premature extrusion is a complication when:
- The tube comes out before 6 months or before middle ear disease has resolved 1, 4
- Recurrent effusion or infections immediately follow tube loss 1, 4
Other Tube-Related Terms to Distinguish
Tube medialization or displacement into the middle ear refers to the tube migrating inward through the tympanic membrane into the middle ear space, which is a true complication requiring surgical removal 1, 5.
Retained tube means the tube remains in place beyond its expected lifespan (>2 years for short-term tubes), which increases complication risks 1, 6.
Tube obstruction or blocked tube occurs when the tube lumen becomes occluded with debris, preventing ventilation 4, 6.
Clinical Management of Extrusion
Caregivers should be educated during the perioperative period about the expected duration of tube function and that spontaneous extrusion is normal 1.
Follow-up examination is required after extrusion to ensure the tympanic membrane has healed properly without persistent perforation 1.
Routine periodic follow-up should continue until the tubes extrude, with examination within 3 months of insertion and ongoing monitoring 1, 7.