Tympanostomy tubes, commonly known as ear tubes, are tiny cylinders surgically placed through the eardrum to treat chronic middle ear issues. Their primary function is to ventilate the middle ear space and equalize pressure, allowing trapped fluid to drain and preventing recurrent infections. The presence of a tube creates an open channel, leading to concerns about whether water exposure is safe. This concern centers on the possibility of water entering the middle ear and causing an infection.
Current Guidance on Water Protection
The long-standing medical advice to always use ear plugs with tubes has largely shifted based on modern clinical evidence. Major professional organizations, including the American Academy of Otolaryngology–Head and Neck Surgery, now state that routine water precautions are generally unnecessary for children with ear tubes. This means ear plugs are typically not required for activities like surface swimming in a clean pool or taking a shower.
Clinical studies show that the infection rate (otorrhea) is not significantly higher in children who swim without ear protection. The surface tension of water acts as a barrier, preventing water from easily passing through the tiny tube under normal conditions. This modern guidance prioritizes normal childhood activities, as mandatory water avoidance can negatively impact swimming skill development.
However, this recommendation is not absolute and depends on individual circumstances. Ear plugs may still be recommended for patients who have had frequent ear drainage episodes or those who experience discomfort when water enters the ear canal. For most patients with tubes, the risk of infection from casual water exposure is minimal.
Anatomy: Why Water Poses a Risk
The ear is divided into the outer, middle, and inner sections, with the eardrum acting as the barrier. The middle ear space is normally sterile and air-filled, receiving ventilation from the Eustachian tube. The tympanostomy tube perforates the eardrum, creating a direct connection between the external environment and this sterile middle ear space.
The risk of infection occurs when water travels through the tube, introducing bacteria or contaminants into the middle ear. This results in a middle ear infection (acute otitis media), which is distinct from swimmer’s ear, an infection of the outer ear canal skin.
When water enters, it can lead to acute tympanostomy tube otorrhea, characterized by discharge. The water itself does not cause the infection; rather, it is the pathogens it carries that colonize the middle ear. Because the tubes allow drainage, these infections often present with visible fluid or pus, rather than the severe pain and pressure associated with an intact eardrum.
Differentiating Water Types and Activities
The need for ear protection is determined by the type of water and the activity level, as water sources vary significantly in their pathogen load and ability to penetrate the tube.
Water Type
Clean, chlorinated pool water presents the lowest infectious risk for surface swimming because chlorine minimizes bacterial concentration. Natural bodies of water, such as lakes, rivers, and oceans, carry a higher concentration of microorganisms. Swimming in these non-treated waters often warrants the use of protective ear plugs to prevent pathogen introduction.
Water Pressure and Activity
The use of ear plugs is consistently recommended for any activity involving significant water pressure against the ear. Diving, jumping into water, or submerging the head deeper than a few feet can force water past the tube due to increased hydrostatic pressure.
Soapy Water
Soapy water, such as in a bathtub, also poses a unique risk. The surfactants in the soap lower the water’s surface tension, making it easier for the water to overcome the tube’s resistance and enter the middle ear.
Recognizing and Managing Water Exposure
If water is suspected to have entered the middle ear, vigilant monitoring for signs of infection is necessary. The most common symptom of a middle ear infection with tubes is drainage (otorrhea) from the ear canal. This discharge may appear thick, cloudy, or yellowish and can sometimes have a foul odor.
Other signs of infection include new or increased ear pain, fever, or noticeable fussiness in young children. Unlike infections with an intact eardrum, pain and pressure may be less intense because the tube allows the infection to drain. If any drainage is observed, contact a healthcare provider, typically an otolaryngologist, for evaluation.
Treatment for tube-related otorrhea is usually managed with antibiotic ear drops, which deliver medication directly to the site of the infection. Prompt attention to drainage is important to prevent complications and ensure the effectiveness of the tubes.