Do children with tympanostomy tubes (ear tubes) require ear plugs when swimming?

Ear Plugs for Children with Tympanostomy Tubes During Swimming

Most children with ear tubes do not need ear plugs when swimming, as water does not usually penetrate through the tubes during normal swimming activities. 1

General Recommendations

• Routine water precautions (ear plugs, swimming caps, or avoiding swimming) are unnecessary for most children with tympanostomy tubes 1
• Surface swimming in chlorinated pools poses minimal risk of middle ear infection for children with ear tubes 2, 3
• Water avoidance can be socially inconvenient and may delay development of important water safety skills 1

Specific Situations Requiring Ear Protection

Ear plugs or other water precautions should be considered in the following circumstances:

• Children who experience pain or discomfort when water enters the ear canal 1
• Children with visible discharge or drainage from the ear canal 1
• Children with frequent or prolonged episodes of ear discharge 1
• Swimming deeper than 6 feet underwater 1
• Swimming in lakes or non-chlorinated pools 1
• Dunking head in bathtub (soapy water has lower surface tension) 1
• Children with immune dysfunction 1
• Children with recurrent or persistent otorrhea, particularly with P. aeruginosa or S. aureus infections 1

Evidence Supporting These Recommendations

• Clinical evidence consistently shows no significant reduction in otorrhea rates with routine water precautions 1, 2
• A prospective study of children with ear tubes found no statistically significant difference in otorrhea incidence between swimmers and non-swimmers 4
• Research demonstrates that water penetration into the middle ear through ventilation tubes is rare during surface swimming 3
• It is unlikely that surface swimming or shallow diving creates enough pressure at the eardrum to allow middle ear penetration 1

Practical Considerations

• If ear plugs are needed, use soft, fitted ear plugs or neoprene headbands 1
• Never use materials like Play-Doh or silly putty as ear plugs, as they can become trapped in the ear canal 1
• If ear drainage occurs after swimming, topical antibiotic ear drops are the recommended treatment 1
• Once tubes become blocked or fall out, ear plugs are not needed if there is no hole in the eardrum 1

Common Pitfalls to Avoid

• Unnecessarily restricting children's water activities when there's no clinical benefit 1
• Failing to recognize situations where ear protection might actually be beneficial (deep diving, lake swimming) 1
• Using inappropriate materials for ear protection that could become lodged in the ear canal 1
• Not monitoring for signs of infection after water exposure, especially in high-risk children 1

Despite evolving evidence against routine water precautions, clinical practice has been slow to change. A survey found that while 47% of otolaryngologists allowed swimming without water precautions, 73% of primary care physicians still recommended them 1, highlighting the importance of updated education for healthcare providers on this topic.