Just Keep Swimming: Research Update on Ear Tubes and Water Exposure

As summer comes into full swing, the activities associated with summer fun peak our excitement for pool days, slip-n-slides, and water parks. However, for the ear infection-plagued children of the world, water fun can quickly turn into excruciating ear pain and two weeks of antibiotic eardrops. As ear infections run rampant in children, common procedures are becoming even more ordinary for medical professionals.

One of the most common pediatric outpatient procedures today is a tympanostomy tube (or ear tube) insertion used to drain fluid from the middle ear. Commonly associated with reduction of repeat ear infections, the tiny tubes also help decrease the risk of hearing
loss. After an ear infection, children normally retain fluid in the ear that usually goes away on its own, but guidelines currently surrounding ear tubes suggest if this fluid lasts for more than three months, a child should be considered for ear tubes. Nevertheless, despite the knowledge circulating around ear tubes and implantation, little awareness surrounds the discussion of tympanostomy tubes and swimming.

Commonly, children with ear tubes are advised to use the following items to prevent water from entering the ear canal and possible disrupting the tube:

  • Earplugs
  • Swim caps
  • Water resistant headbands
  • Complete water abstinence

Swimming below the surface increases pressure on the tube and the likelihood of water entering the tube. Once the water enters the tube, the moist environment fosters bacteria growth, which could result in otorrhea, or infection of the ear. Therefore, medical professionals deduced that decreased water exposure would result in decreased ear infection frequency.

However, a study conducted in 2009 and published in the Journal of the Chinese Medical Association examined 14 children with ear tubes, who were allowed one hour of recreational surface swimming without ear protection. Using 22 ears for tympanic observation, the study found only one ear that had any water penetration after swimming. Given the children stayed in treated water at surface level, according to the study results, neither water preventative accessories/treatment (ear plugs or drops) nor avoiding swimming were necessary.

An additional study published in The Laryngoscope in 2014 did uncover that the risk of ear infections does correlate with increased depth below the surface (greater than 5 feet below) as well as exposure to soapy or untreated water like lake water. Further, the older the child often with more inclination to be swimming deeper under the surface (greater than 2 feet), the more likely earplugs are to be helpful rather than burdensome.

More recent research, listed below, has concluded that with normal, surface level swimming practices, earplugs and other water preventative accessories are not necessary to avoid ear infections or tube complications. Although caution should be used for swimming at greater depths or in untreated water, in most cases the pool can be enjoyed without the often-annoying accessories. The next time water woes put a damper on summer fun, say goodbye to the plugs and caps and just keep swimming.

For links to more recent research on tympanostomy tubes and swimming visit:

http://www.ncbi.nlm.nih.gov/pubmed/23818543 http://www.ncbi.nlm.nih.gov/pubmed/15689760