The placement of ear tubes, known medically as tympanostomy tubes, is a common procedure designed to help the middle ear drain and ventilate. These devices are primarily inserted to treat Otitis Media, an infection or fluid buildup in the space behind the eardrum. A common question is whether these tubes prevent the separate condition called Swimmer’s Ear, or Otitis Externa. A person with tubes can still develop Swimmer’s Ear because the tubes only affect the middle ear, not the outer ear canal where that infection occurs.
Understanding the Two Types of Ear Infection
Ear infections are categorized by their location in the ear’s anatomy. Otitis Externa, or Swimmer’s Ear, is an infection of the outer ear canal, typically caused by bacteria or fungi thriving when water is trapped, breaking down the skin’s protective barrier. Pain is often severe and worsens when the outer ear is tugged or moved.
Otitis Media, which tubes address, affects the middle ear space behind the eardrum. This infection is usually triggered by a respiratory infection that causes the Eustachian tube to swell, trapping fluid. Tympanostomy tubes create an opening in the eardrum, bypassing the blocked Eustachian tube to allow air and fluid drainage.
Water Exposure and Tympanostomy Tubes
The main concern regarding water exposure with tubes is the potential for water to enter the middle ear through the tube, leading to a discharge called Otorrhea. Otorrhea is the most frequent issue following tube placement, occurring in up to one-quarter of children at some point. When the middle ear becomes contaminated, an infection can develop, which the tube allows to drain out of the ear canal.
Current medical understanding suggests that routine water precautions, such as using earplugs for bathing or surface swimming, are unnecessary for most children with tubes. Studies show that the incidence of middle ear infection is often not significantly different between children who use ear protection and those who do not. This is likely due to surface tension, which prevents most clean, chlorinated water from passing through the tiny tube opening. Physicians still advise caution for deep diving or swimming in heavily contaminated water, such as certain lakes or rivers, where the risk of forcing bacteria past the tube is higher.
Preventing Outer Ear Infections
Since the outer ear canal remains susceptible to infection, a proactive approach is necessary to prevent Swimmer’s Ear. The primary goal is to ensure the outer ear canal is dried thoroughly after any water exposure. After swimming or bathing, the ear should be gently blotted with a towel to remove excess moisture.
To aid in drying, a handheld hairdryer can be used on the lowest setting, held several inches away from the ear. This helps evaporate trapped moisture without risking injury to the ear canal skin. Acidic ear drops, like those containing alcohol or vinegar, should not be used when tympanostomy tubes are in place. These solutions could pass through the tube and cause irritation or damage to the middle ear structures.
Recognizing and Treating Ear Discharge
The most noticeable sign of an ear infection with tubes is the appearance of drainage, or Otorrhea, from the ear canal. This discharge can vary, ranging from thin and clear to thick, cloudy, yellow, green, or occasionally bloody. Unlike a typical middle ear infection without tubes, pain or fever is often absent because the tube allows pressure and fluid to escape.
The standard approach to treating uncomplicated Otorrhea involves using antibiotic ear drops. The tube allows the topical medication to be delivered directly to the site of infection in the middle ear, which is often more effective than oral antibiotics. Common prescriptions include fluoroquinolone drops like ofloxacin or ciprofloxacin-dexamethasone. Contact a physician immediately upon noticing discharge so they can confirm the infection and prescribe the appropriate drops. If drainage persists for more than 7 to 10 days despite treatment, a follow-up appointment is necessary to ensure the tube is clear and the infection is resolving.