Children who have tympanostomy tubes for chronic otitis media and who swim may be at increased risk for otorrhea and ear infections. For water to enter the middle ear through a tympanostomy tube it must be under sufficient pressure to do so. For an infection to occur the water must contain pathogenic bacteria. Children with tubes can usually swim without serious complications provided some simple precautions are taken.

Risk Factor

Low Risk

Moderate to High Risk

depth of swimming

surface and shallow water

deeper levels (> 60 cm)

water entry

regular entry


type of water

chlorinated swimming pool

lakes, oceans or water with particulate matter


showering, hair rinsing or bathing

immersing head in soapy and dirty water

history of otorrhea

none or rarely

frequent or repeated


Steps that can help reduce risk:

(1) use of prophylactic ototopical drops

(2) use of ear plugs with head band

(3) restriction of prohibited activity


Arguments against routine use of ear plus in all situations:

(1) Some studies have shown a higher rate of otorrhea in swimmers with ear plugs than those without.

(2) Ear canal occlusion may increase the risk of infection,

(3) Concurrent upper respiratory tract infection may be a more important cause of otorrhea.


To read more or access our algorithms and calculators, please log in or register.