Is it safe to swim in treated pools for children with tympanostomy tubes

A new study was published in Otolaryngology-Head and Neck SurgeryThe peer-reviewed journal of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) found that children with tympanostomy tubes who swam in treated pools were not at increased risk for ear bleeding, while children with untreated otorrhea or those exposed to natural water bodies were significantly more likely to develop frequent otorrhea.

Tympanostomy tube placement, commonly known as ear tube surgery, is one of the most frequently performed surgical procedures in children in the United States, usually recommended for those with frequent ear infections or persistent fluid in the middle ear.

“The role of water precautions in tympanostomy tubes has been extensively debated, yet empirical evidence regarding the effect of water type and otorrhea exposure is limited,” said Kavita Dedhia, MD, MSHP, assistant professor in the Department of Otorhinolaryngology Head and Neck Surgery at the University of Pennsylvania Perelman School of Medicine. “We identified an association between increased otorrhea episodes and exposure to untreated water. Although this is not a definitive study, it may help providers advise families about when to consider water precautions.”

These findings are consistent with AAO-HNSF’s 2022 Clinical Practice Guidelines (Updated) on tympanostomy tubes in children, as specified in the Key Action Statement 15 Clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. CPG notes that water precautions are best reserved for select children rather than routinely enforced, with the preferred approach being to allow unrestricted water activity at first and taking precautions only if problems arise. Exceptions include children with recurrent or persistent otorrhea – especially those P. aeruginosa Or S. aureus In middle ear cultures – those with immune dysfunction, those experiencing ear discomfort while swimming, and those exposed to heavily contaminated water or engaged in deep diving.

The authors acknowledge several limitations, including the potential for recall bias among caregivers and the observational nature of the study design, which limits causal conclusions. They call for prospective studies and interventional trials to further elucidate the biological mechanisms underlying water-related ear drainage and to identify additional modifiable risk factors. The study also found that younger children were more likely to experience frequent ear discharges, regardless of the type of water exposure, which is consistent with prior research on acute otitis media in childhood.

The authors call for prospective studies and interventional trials to further elucidate the biological mechanisms underlying water-related ear drainage and identify additional modifiable risk factors.