Dr. Greene, my 4-year-old son recently had ear tubes placed. My doctor said that it is okay for him to go swimming (I think). My friends look at me horrified. They say he needs to wear custom ear plugs. Their doctors told them that their children with ear tubes shouldn’t let their ears get wet. My son loves the water. What should I do?
Dr. Greene’s Answer:
Most parents of children who have had PE tubes placed are happy with the results. They report fewer ear infections, easier clearance when infections do occur, and less worrying about whether their children have ear infections or not.
For many parents, the most vexing issue is the need for water precautions. Neither making their children wear ear plugs nor limiting water exposure is very fun. For years otolaryngologists (ear, nose, and throat doctors) have cautioned against allowing water in an ear that has an open tube in the eardrum. Recently, some have begun to suggest that swimming precautions are unnecessary — that water does not get through the tiny tubes into the middle ear. Over the last few years there has been a flurry of articles arguing both points of view. Your quandary is the same one that faces experts.
In the late 1990s, an excellent study was published in the Archives of Otolaryngology and Head and Neck Surgery that shed light on this controversy. The investigators followed 399 children with PE tubes. They were divided into four groups at the beginning of the study. Children in the first group were encouraged to swim without precautions. Those in Group 2 received antibiotic ear drops each night after they had been in the water. Those in group 3 wore molded ear plugs whenever they were in the water. Children in all three of these groups were instructed against diving and swimming more than 6 feet beneath the surface (since water under pressure presumably enters the middle ear through the tubes more readily). The fourth group consisted of confirmed non-swimmers. All parents were warned not to allow soapy water to enter the ear during bathing (since the lower surface tension of soapy water could allow it to penetrate the tubes more easily. Also, soapy water could be more irritating to the middle ear if it gains entrance).
Drum roll, please…
Children in the three groups of swimmers experienced no intergroup difference in the incidence either of ear infections or of draining ears regardless of plugs or ear drops. There was also no difference found between the swimmers and the non-swimmers.
Conclusion — relax and follow your doctor’s advice. Let your son enjoy swimming. Forget ear plugs. If your son turns out to be one of the unfortunate few who gets frequent ear infections in the summer months even after tubes, you might want to try water precautions on the chance that he is particularly sensitive to water exposure.
Perhaps sometime soon, someone will do a study about whether diving, underwater swimming, and soapy bathwater precautions are all really necessary. In the meantime, better safe than sorry.
Exciting new update!!!:
More recent studies have concurred with the conclusion that ear plugs are not needed for routine, surface swimming.
To look at the impact of soapy water and deeper water swimming, one study used a model head in various settings. The study showed that showering, hair rinsing, and submersion in clean tap water did not increase water entry into the middle ear. However, soapy water and deeper swimming (over ~2 feet) did.
So it appears that recent studies agree that ear plugs are not needed for regular, surface swimming. However, one may consider ear plugs for soapy water baths and deep swimming until more research can clarify the situation.
Salata JA et al. 122:276-280,Arch Otoloaryngol Head Neck Surg. March 1996Herber RL et al. Arch Otolaryngol Head Neck Surg. October 1998. Lee D et al. Laryngoscope. April 1999. Kaufmann TU et al. Schweitz Med Wochenshr. October 1999. Carbonell R et al. Int J Pediatr Otorhinolaryngol. December 2002.