Tympanostomy tube placement, often called ear tube surgery, is a common pediatric procedure used to manage chronic middle ear problems. A primary concern following this procedure is determining when normal activities, particularly those involving water exposure, can safely resume. Since the tubes create a direct channel from the outer ear canal into the middle ear space, understanding the risks and necessary precautions surrounding water contact is important for preventing infection.
The Purpose of Tympanostomy Tubes
Tympanostomy tubes are small, hollow cylinders, often made of plastic or metal, inserted through a surgical opening in the eardrum (tympanic membrane). They are used primarily to treat recurrent acute otitis media (ear infections) or persistent otitis media with effusion (“glue ear”). The procedure is performed when fluid builds up persistently behind the eardrum, which can impair hearing and lead to repeated infections.
The tube’s function is to ventilate the middle ear, allowing air to flow in and maintaining balanced air pressure. This aeration prevents the accumulation of fluid that can become a breeding ground for bacteria. By creating a drainage pathway, the tubes relieve pressure and allow trapped fluid to escape. Most short-term tubes remain in place for six to 15 months, eventually falling out naturally as the eardrum heals.
Immediate Post-Operative Water Restrictions
The most sensitive period for water exposure is immediately following the surgical placement of the tubes. The tiny incision made in the eardrum (myringotomy) requires time to heal around the tube. Most specialists recommend maintaining a strictly dry ear environment for approximately ten to fourteen days after the procedure.
This restriction allows the surgical site to stabilize and minimizes the chance of bacteria-laden water reaching the middle ear before healing occurs. During this time, activities like swimming or fully submerging the head must be avoided completely. For routine hygiene, such as showering or hair washing, the ear canals should be protected using cotton balls coated in petroleum jelly or commercial earplugs. Baths should be shallow, and care must be taken to keep the head above the water line to prevent accidental splashing.
Long-Term Water Safety and Environmental Risks
Once the initial healing period of about two weeks is complete, the rules for water exposure become less restrictive, depending on the type of water involved. For most children with tubes, routine water precautions like mandatory earplug use are unnecessary for surface swimming. This guidance reflects evidence that water penetration into the middle ear is rare during casual surface swimming, and routine protection does not significantly reduce the rate of ear infections.
Swimming in clean, chlorinated pools is considered safe without specific ear protection. Chlorine acts as a disinfectant, minimizing the risk of infection should a small amount of water enter the tube. However, the risk changes significantly in environments where water quality is uncertain, such as lakes, rivers, or non-chlorinated ponds. These natural water sources contain higher concentrations of microorganisms and require the use of protective gear, such as earplugs or a snug neoprene headband, to prevent contamination.
Special attention must be paid to soapy water, which carries a higher potential for passing through the tube due to its lower surface tension. Precautions are often recommended during bath time, particularly if the child is prone to dunking their head or splashing aggressively. Activities that involve significant water pressure changes, like diving or swimming deeper than six feet underwater, should be avoided or require specialized, custom-fitted ear protection. The ongoing safety protocol should always be guided by the specific recommendations of the operating surgeon.
Recognizing and Managing Drainage
Fluid drainage from the ear, known as otorrhea, is a common occurrence with ear tubes, even without water exposure. The presence of drainage often indicates that the tube is functioning as intended, allowing fluid to escape the middle ear instead of accumulating behind the eardrum. Immediately after surgery, a small amount of clear, yellow, or blood-tinged fluid is expected for a few days.
If drainage appears thick, cloudy, or foul-smelling, it may signal a new infection or persistent inflammation. The preferred course of action is the use of antibiotic ear drops, which deliver medication directly to the site of the infection through the tube. These drops are usually more effective than oral antibiotics because they target the middle ear space directly. If the drainage continues for five to seven days despite using the prescribed drops, or if the patient experiences increasing pain, contact a healthcare provider for further evaluation.