1. Just Keep Swimming: Research Update on Ear Tubes and Water Exposure
As summer comes into full swing, the activities associated with summer fun perk our
excitement for pool days, slip-n-slides, and water parks. However, for the ear infection-plagued
children of the world, water fun can quickly turn into excruciating ear pain and two weeks of
antibiotic eardrops. As ear infections run rampant in children, common procedures are
becoming even more ordinary for medical professionals.
One of the most common pediatric outpatient procedures today is a tympanostomy
tube (or ear tube) insertion used to drain fluid from the middle ear. Commonly associated with
reduction of repeat ear infections, the tiny tubes also help decrease the risk of hearing loss.
After an ear infection, children normally retain fluid in the ear that usually goes away on its
own, but guidelines currently surrounding ear tubes suggest if this fluid lasts for more than
three months, a child should be considered for ear tubes. Nevertheless, despite the knowledge
circulating around ear tubes and implantation, little awareness surrounds the discussion of
tympanostomy tubes and swimming.
Commonly, children with ear tubes are advised to use earplugs, swimcaps, water
resistant headbands, or even practice complete abstinence from water exposure to prevent
water from entering the ear canal and possibly disrupting the tube. Swimming below the
surface increases pressure on the tube and the likelihood of water entering the tube. Once the
water enters the tube, the moist environment fosters bacteria growth, which could result in
otorrhea, or infection of the ear. Therefore, medical professionals deduced that decreased
water exposure would result in decreased ear infection frequency.
However, a study conducted in 1998 and published in The Archives of Otolaryngology
and Head and Neck Surgery placed children with ear tubes in four different test groups
(children swimming without precaution, children using antibiotic ear drops after swimming,
children using earplugs, and non-swimming children). The study found no difference in
frequency of ear infections or draining ears regardless of swimtime or precautionary
technique. Given the children stayed in treated water at surface level, according to the study
results, neither water preventative accessories/treatment (ear plugs or drops) nor avoiding
swimming had any effect on the ear tube’s usefulness.
An additional study published in The Laryngoscope in 2014 did uncover that the risk of
ear infections does correlate with increased depth below the surface (greater than 5 feet
below) as well as exposure to soapy or untreated water (like lake water). Further, the older the
child is with more inclination to be swimming deeper under the surface (greater than 2 feet),
the more likely earplugs are to be helpful rather than burdensome.
More recent research has concluded that with normal, surface level swimming
practices, earplugs and other water preventative accessories are not necessary to avoid ear
infections or tube complications. Although caution should be used for swimming at greater
depths or in untreated water, in most cases the pool can be enjoyed without the often-
annoying accessories. The next time water woes put a damper on summer fun, say goodbye to
the plugs and caps and just keep swimming.