Children with tympanostomy tubes, commonly known as ear tubes, who swim in treated pools are not at increased risk of developing ear drainage, according to a study published in Otolaryngology−Head and Neck Surgery and announced on Mar. 30. The research found that exposure to untreated or natural bodies of water is linked to significantly higher chances of recurrent otorrhea, or ear discharge.
Tympanostomy tube placement is one of the most frequently performed surgeries among children in the United States. It is typically recommended for those who have recurring ear infections or persistent fluid buildup in the middle ear.
Kavita Dedhia, MD, MSHP, Assistant Professor at the Department of Otorhinolaryngology Head & Neck Surgery at the Perelman School of Medicine at the University of Pennsylvania said: "The role of water precautions in tympanostomy tubes has been extensively debated, yet empirical evidence regarding the impact of water type and otorrhea risk is limited. We identified an association between increased otorrhea episodes and exposure to untreated water. Although this is not a definitive study, it can guide providers to counsel families on when to consider water precautions."
The findings support guidance from the American Academy of Otolaryngology−Head and Neck Surgery Foundation's 2022 Clinical Practice Guideline on Tympanostomy Tubes in Children (Update). This guideline advises against routine use of preventive measures such as earplugs or avoiding swimming for all children with tympanostomy tubes. Instead, it recommends unrestricted water activity unless problems occur. Precautions may be considered for certain groups including those with ongoing drainage issues—especially if specific bacteria are present—children with immune dysfunctions, those experiencing discomfort while swimming, or those exposed to heavily contaminated waters or deep diving.
The authors note limitations such as potential recall bias among caregivers and that their observational study design cannot establish cause-and-effect relationships. They call for further prospective studies and intervention trials to better understand why some children develop drainage after water exposure and what other risk factors might be involved.
