Ears with tympanostomy tubes need a lighter touch than normal ears, because the tube creates an intentional opening in the eardrum that connects the ear canal directly to the middle ear space. The standard advice for everyday ears (leave them alone, let the canal self-clean) mostly still applies, but several common cleaning habits become genuinely risky when a tube is in place. Getting this right matters because the tube is doing a job, keeping the middle ear ventilated and preventing fluid buildup, and anything that introduces bacteria or irritants through that opening can cause infection and drainage.
What a Tube Actually Does and Why It Changes Cleaning
A tympanostomy tube is a tiny cylinder, usually a few millimeters across, placed through the eardrum during a brief surgical procedure. Its purpose is to ventilate the middle ear continuously and prevent fluid from accumulating behind the eardrum, particularly in people (most often children) who get repeated ear infections or persistent middle ear fluid that won’t resolve on its own.1PubMed Central. An Overview of the Tympanostomy Tube In a normal ear, the eardrum is a sealed barrier. Wax, water, and debris in the ear canal can’t easily reach the middle ear. Once a tube is sitting in that eardrum, the barrier has a hole in it. Anything that enters the canal has a potential path into the middle ear, where it doesn’t belong and where the tissue is more delicate and infection-prone.
This single fact drives nearly every cleaning precaution. You aren’t dealing with an ear that’s more fragile in some vague way. You’re dealing with an ear where the canal and middle ear are physically connected, so liquids, pressure, and foreign objects all pose risks they wouldn’t in an intact ear.
Safe Day-to-Day Cleaning
The outer ear (the part you can see, plus the very entrance of the canal) can be cleaned normally. A damp washcloth wiped around the outside of the ear and just inside the opening is the safest approach. This handles visible wax or debris without pushing anything deeper. It’s essentially the same advice otolaryngologists give for ears without tubes, just enforced more strictly because the consequences of overreaching are higher.
Earwax still forms in an ear with tubes, and the canal’s natural outward migration of skin cells continues to move wax toward the opening. In most cases, the ear will clean itself. If wax builds up enough to become visible or to muffle sound, your doctor can remove it using instruments designed for the job, typically a curette or gentle suction performed under magnification. This is a quick office visit, not a procedure that requires sedation, and it avoids the risks of at-home removal methods.
What Not to Put in the Ear
Several common ear-cleaning tools and products become particularly hazardous when tubes are present.
- Cotton swabs: These are a bad idea even in ears without tubes. They compress wax deeper into the canal and can scratch the canal skin, increasing infection risk. In an ear with a tube, a swab can also push wax or debris directly against or through the tube, potentially clogging it or introducing bacteria into the middle ear. It can even dislodge the tube itself.
- Ear irrigation kits: Bulb syringes and pressurized water irrigation systems flush liquid forcefully into the canal. In an intact ear, the eardrum stops that water. With a tube, the water flows straight through into the middle ear, carrying bacteria with it. This is one of the clearest “never do this” rules for tubed ears.
- Over-the-counter earwax drops: Most wax-softening drops (carbamide peroxide, mineral oil, or similar) are designed to be used in a sealed ear canal, where they can soften wax and then be rinsed out. With a tube, these liquids can pass into the middle ear. Hydrogen peroxide deserves special caution: an animal study found that when hydrogen peroxide reached the middle ear, it caused severe inner ear damage, with hearing thresholds jumping dramatically and some animals losing measurable hearing or vestibular function entirely.2PubMed. The effect of hydrogen peroxide applied to the middle ear on inner ear function That’s an animal model and the concentrations were high, but it’s a strong reason to keep peroxide out of an ear that has a direct path to the middle ear.
- Ear candles: These don’t work in any ear and pose burn and wax-drip risks. With a tube in place, there’s the added absurdity that the canal isn’t even sealed, so whatever mechanism proponents claim (which has never been validated) couldn’t apply.
The common thread is simple: if it involves pushing something into the canal or flushing liquid through it, don’t do it yourself when a tube is present. Leave wax management to the doctor.
Keeping Water Out During Baths and Showers
Water exposure is one of the most common concerns parents have about ear tubes, and the evidence here is more nuanced than the blanket warnings many families receive. A randomized controlled trial that compared children who swam and bathed without earplugs to those who wore them found a small but statistically significant increase in ear drainage episodes in the unprotected group.3PubMed. Water precautions and tympanostomy tubes: a randomized, controlled trial However, the researchers concluded that the clinical impact was small enough that routine use of earplugs may be unnecessary.
What does that mean in practice? For ordinary bathing and showering, surface-level water exposure doesn’t seem to pose a major risk. A child sitting in a bathtub with ears above the waterline, or an adult in the shower, is unlikely to force enough water through the tube to cause trouble. The risk goes up when the ear is actively submerged, especially with any pressure behind the water. That’s why many ENT doctors draw a line between surface splashing (usually fine) and underwater activity (higher risk). Soapy or dirty bathwater is more concerning than clean water, since it carries more bacteria. A reasonable approach for bath time is to keep the ears above water and avoid deliberately pouring water over the head. For hair washing, tilting the head to keep water flowing away from the ear with the tube is often enough.
Swimming With Tubes
Swimming introduces more variables than a bath because it involves submersion and, in many pools, chlorinated or natural-body water that may contain bacteria. The debate among ear specialists about whether earplugs are necessary for surface swimming in pools has gone back and forth for years. Some surgeons tell every family to use plugs; others say pool swimming without plugs is fine but lake or ocean swimming needs protection.
Testing of commercial earplugs showed that even with plugs in place, water still penetrated in a substantial percentage of ears, especially with deeper submersion. In one study, water got through in about 44% of ears during surface swimming, 67% with horizontal submersion, and 88% with vertical submersion (diving head-first). The type of plug mattered significantly: soft moldable silicone earplugs had the lowest failure rate across all conditions.4PubMed. Efficacy of commercial earplugs in preventing water intrusion during swimming Among the brands tested, the soft silicone type outperformed others, especially during horizontal submersion, where it was meaningfully better than another waterproof design.5Otolaryngology–Head and Neck Surgery. Efficacy of Commercial Earplugs in Preventing Water Exposure
The practical takeaway: earplugs help but aren’t a perfect seal, and they help most during surface-level swimming rather than diving. If your child swims at the surface in a chlorinated pool, the risk of infection even without plugs is fairly low. For lake swimming, ocean swimming, or any activity involving diving or going underwater, plugs are a more sensible precaution because the water is dirtier and the submersion pressure pushes water through more aggressively. Custom-molded earplugs made by an audiologist offer the best fit, but off-the-shelf soft silicone plugs are a reasonable and cheaper alternative for most kids.
What to Do When You See Drainage
Drainage from an ear with a tube, called otorrhea, is one of the most common complications and doesn’t necessarily mean something has gone badly wrong. It often means the tube is doing exactly what it was designed to do: letting fluid escape outward through the canal instead of building up in the middle ear. Still, drainage signals that an infection or inflammation is present and needs treatment.
How drainage is treated matters a lot. A large trial compared three approaches for children with acute tube drainage: antibiotic-steroid eardrops, oral antibiotics, and watchful waiting. The eardrops were dramatically better. At two weeks, only about 5% of children treated with antibiotic-steroid eardrops still had drainage, compared to 44% of those given oral antibiotics and 55% of those in the observation group. The drainage also cleared faster with drops: a median of four days versus five for oral antibiotics and twelve for observation alone.6PubMed. A Trial of Treatment for Acute Otorrhea in Children with Tympanostomy Tubes
A meta-analysis confirmed this pattern, finding that topical antibiotic-steroid drops had the highest probability of being the most effective treatment for tube-related drainage, followed by antibiotic-only drops. Oral antibiotics ranked below both topical options.7Pediatrics. Prevention and Treatment of Tympanostomy Tube Otorrhea: A Meta-analysis This is worth knowing because some parents assume they need an oral antibiotic prescription for tube drainage, and some doctors still prescribe one reflexively. The evidence strongly favors eardrops as the first-line treatment.
When you see drainage, gently wipe the outer ear with a clean cloth or tissue. Don’t insert anything into the canal to try to clean it out. Contact your doctor for a prescription for antibiotic-steroid eardrops. Most drainage episodes resolve within a few days of starting drops. If drainage persists beyond a week or two, or if it’s bloody or has a foul odor, that warrants a closer look from the ENT.
Administering Eardrops Correctly
Since eardrops are the go-to treatment for tube-related drainage and are sometimes prescribed preventively (for example, right after surgery), knowing how to give them properly is a practical skill. The drops need to actually reach the tube, which means just tilting the head and squeezing the bottle isn’t always enough.
Have the person lie down with the affected ear facing up. Place the prescribed number of drops into the canal. Then gently press on the small flap of cartilage at the front of the ear opening (called the tragus) and pump it a few times. This pushes the drops deeper and helps them pass through the tube into the middle ear. Stay in that position for a minute or two so the drops don’t immediately run out. If both ears have tubes, repeat on the other side. For young children, distraction with a phone or toy during the “lying still” phase makes this considerably easier.
One common mistake is using drops that are too cold. Room-temperature or body-temperature drops are more comfortable and less likely to cause dizziness. If you store the bottle in the fridge, warm it in your hands for a minute or two before use. Cold liquid hitting the middle ear through the tube can trigger a brief vertigo spell that, while harmless, is unpleasant and can make a child resist future doses.
When Multiple Sets of Tubes Are Needed
Most ear tubes are designed to stay in place for six to eighteen months before the eardrum naturally pushes them out. Some children need a second or third set because their underlying eustachian tube dysfunction persists. This is more common in children with certain conditions, including Down syndrome, cleft palate, and other craniofacial differences.
A retrospective study of children with Down syndrome who received tubes found that a majority needed two or more sets over an average follow-up of nearly five years. Long-term complications were significantly more common in those who required three or more sets, including chronic eardrum perforations, retraction of the eardrum, and cholesteatoma (an abnormal skin growth in the middle ear).8PubMed. Outcomes of tympanostomy tube placement in children with Down syndrome–a retrospective review These complications aren’t unique to Down syndrome but are a reminder that repeated tube placements carry cumulative risks to the eardrum.
For families managing multiple sets of tubes, the cleaning and water precautions remain the same each time. What changes is the importance of regular follow-up. With each set, the ENT needs to monitor the eardrum for thinning, scarring, or retraction that could eventually affect hearing even after the tubes are gone. Keeping up with scheduled visits, even when the ears seem fine, helps catch these issues before they become problems that need surgical repair.
After the Tube Falls Out
When a tube extrudes on its own, which is the expected outcome, you might find a tiny plastic cylinder in the ear canal, on a pillow, or you might never notice it at all. The eardrum usually heals over the small hole within a few weeks. During that healing window, the same water precautions that applied while the tube was in place still apply, because the perforation is still open. Once the ENT confirms the eardrum has fully closed, normal ear-cleaning habits can resume and water precautions can be dropped.
Occasionally the hole doesn’t close on its own. A persistent perforation after tube extrusion is more likely in children who’ve had multiple sets of tubes or who had long-duration tubes (T-tubes) that stay in for years rather than months. A small perforation might not cause any symptoms and can sometimes be left alone. Larger ones, or those causing recurrent infections or hearing loss, can be repaired with a minor surgical procedure called a tympanoplasty. If your child has had tubes fall out but you’re still seeing drainage or hearing concerns, that’s a sign the perforation may not have healed and warrants an exam.
Flying and Pressure Changes
One underappreciated benefit of ear tubes is that they make pressure equalization during flights essentially automatic. In a normal ear, the eustachian tube has to open and close to equalize pressure between the middle ear and the atmosphere. When that tube is dysfunctional (which is often why the ear tubes were placed to begin with), flying can be painful. With a tympanostomy tube in place, air flows freely through the tube and pressure equalizes on its own. Most children with ear tubes fly without any discomfort at all.
No special ear cleaning or preparation is needed before flying with tubes. The tube handles the pressure. The only thing to be aware of is that if the tube is clogged with dried wax or discharge, the pressure-equalization benefit is reduced. Keeping up with routine ENT checks helps ensure the tube is patent and functioning.