Ear tubes (tympanostomy tubes) are small, cylindrical devices placed through the eardrum, usually in children, to equalize pressure and allow trapped fluid to drain from the middle ear. This procedure treats chronic middle ear infections (otitis media) or persistent fluid buildup that impairs hearing. A frequent concern is whether the small opening means water must be strictly avoided, particularly when swimming.
Understanding Ear Tubes and Water Exposure
The current medical consensus has shifted away from routine water precautions for all patients with ear tubes. Historically, strict avoidance of water was the standard, but modern research suggests this is often unnecessary. The small size of the tube and the natural surface tension of clean water generally prevent fluid from passing through the tube and into the middle ear space.
For casual swimming in clean, treated water, such as a properly chlorinated swimming pool, protection is usually not required. Chlorine acts as a disinfectant, minimizing the risk posed by any small amount of water that might reach the middle ear. Gentle, surface swimming and splashing are typically considered safe without the need for earplugs or headbands.
However, the safety margin changes significantly with the type of water and the activity level. While surface tension is protective, increased pressure or contaminants can overcome it. Deeper or more forceful water contact increases the likelihood of penetration. If a patient experiences pain or discomfort when water enters the ear canal, protective measures should be considered for all water exposure.
Specific Water Activities Requiring Protection
While routine swimming in chlorinated pools is generally safe, certain high-risk scenarios and environments still require the use of protective gear like earplugs or swimming headbands. Any activity that involves deep submersion, such as diving or swimming more than six feet underwater, significantly increases the water pressure on the eardrum. This pressure can easily overcome the protective surface tension, forcing water through the tube and into the middle ear.
Exposure to water with a high bacterial load is another situation where protection is strongly recommended. This includes non-chlorinated bodies of water like lakes, rivers, and oceans, as well as poorly maintained hot tubs. If water from these sources enters the middle ear, the high concentration of microorganisms substantially increases the risk of developing an infection. Soapy water, such as in a bathtub, can also be problematic because soap lowers the water’s surface tension, making it easier for the fluid to pass through the tube.
In these higher-risk circumstances, effective protection is necessary to maintain the barrier against contaminated water. Custom-molded earplugs offer the most secure seal, precisely fitting the unique contours of the ear canal to prevent water ingress. For additional security, a neoprene swimming headband can be worn over the earplugs to help keep them in place and deflect water away from the ear opening. Over-the-counter silicone or wax plugs are available, but they must form a tight, complete seal to be effective against pressurized or contaminated water.
Recognizing and Addressing Water Entry
Despite precautions, water can occasionally enter the middle ear, or an infection may develop. The most noticeable sign is ear drainage, medically termed otorrhea. This discharge may be thin, thick, cloudy, or slightly bloody, sometimes accompanied by a foul odor or a persistent wet sensation. Unlike a typical ear infection without tubes, pain and fever are often absent when drainage occurs through an open tube.
If drainage is noticed, gently dry the outer ear with a clean towel; cotton swabs should not be inserted into the ear canal. Discharge indicates the middle ear is draining, which is the intended function of the tube, but it also signals a potential infection that needs monitoring. If the drainage is persistent, lasting more than 24 to 48 hours, or if it is accompanied by increasing pain or fever, medical consultation is required.
Treatment for Drainage
In cases of a confirmed infection with drainage through the tube, the standard treatment is topical antibiotic ear drops, such as those containing ciprofloxacin and dexamethasone. These drops are highly effective because they deliver the medication directly to the site of the infection in the middle ear. Oral antibiotics are typically reserved for more severe cases or when drainage does not clear up quickly with drops. Following the medical provider’s instructions for the duration and technique of administering the drops is important for resolving the infection.