New Evidence on Swimming and Tympanostomy Tube Outcomes

For decades, physicians and audiologists have warned parents that their children with tympanostomy tubes (TT) should not swim without ear plugs. In fact, there are even companies that make earplugs targeted at children who have undergone TT placement. Despite new guidelines in 2013 (Rosenfeld et al., 2013), surveys of healthcare providers indicate no consensus on water precautions for children who have TT.

Researchers from the Children’s Hospital of Philadelphia (CHOP) Division of Pediatric Otolaryngology recently completed a cross-sectional survey and published the results. Caregivers of 137 patients who had undergone TT placement at least six months prior were surveyed about their child’s water exposure to “dirty” water (i.e., ocean, lake, untreated pool water), “clean” water (i.e., chlorinated or salt-treated pool water), and any episodes of otorrhea since surgery.

Results revealed that patients exposed to dirty water had 3.18 times the odds of developing recurrent TT otorrhea compared with those not exposed to dirty water. There was no association between clean water exposure and TT otorrhea.

The authors concluded that for children who have undergone TT placement, untreated or natural water sources may be associated with increased otorrhea. Conversely, swimming in treated pools appears safe. These findings should promote individualized water precautions instead of universal restrictions.

References

Irace, A. L., Giordano, T., Williams, A., Karpink, J., Kim, M., & Dedhia, K. (2025). Outcomes and characteristics of water exposure in children with tympanostomy tubes. Otolaryngology–Head and Neck Surgery, 174(2), 422–429.

‌Rosenfeld, R. M., Schwartz, S. R., Pynnonen, M. A., Tunkel, D. E., Hussey, H. M., et al. (2013). Clinical practice guideline Otitis media with effusion (update). Otolaryngology–Head and Neck Surgery, 149(1), 8–16.