👂 What are ear tubes and why do children get them?
Ear tubes are tiny cylinders surgically inserted through the eardrum to let air into the middle ear and drain fluid from recurrent ear infections. Ear tubes — medically called tympanostomy tubes or pressure equalization (PE) tubes — are tiny cylinders surgically inserted through the eardrum to allow air into the middle ear and help drain fluid that accumulates due to recurrent ear infections or chronic fluid buildup (otitis media with effusion).
They are one of the most common pediatric surgical procedures performed in the United States, with approximately 500,000 children receiving ear tubes each year. Most children who get them are between ages 1 and 4, though older children and adults can receive them too.
The tubes typically stay in place for 6–18 months and fall out on their own. They improve hearing, reduce pain, and dramatically decrease the frequency of ear infections for most children who receive them.
📋 What do current medical guidelines say about swimming?
Current guidance from the American Academy of Otolaryngology is that routine surface swimming in chlorinated pool water does not require ear plugs for most children with standard tubes. For many years, the standard advice was that children with ear tubes should always wear ear plugs when swimming — and many families were told to avoid swimming entirely, especially underwater. That guidance has changed.
The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) updated their clinical practice guidelines, and the current consensus among most ENT physicians is that routine surface swimming in chlorinated pool water does not require ear plugs for children with standard tympanostomy tubes in place.
The reasoning: chlorinated pool water is far less likely to cause infection than untreated water, and the water pressure during normal surface swimming is generally not high enough to force significant water through the tubes into the middle ear. Studies comparing children who wore ear plugs versus those who didn't found no significant difference in tube complications or infection rates for routine pool swimming.
However, this does not mean all water activity is without restriction. Your child's individual ENT doctor's guidance is what matters most — they know your child's specific tube type, placement, ear history, and any complicating factors.
🚫 Which activities should you approach carefully or avoid?
Diving, deep submersion, forceful dunking, and swimming in untreated natural water warrant more caution or a direct conversation with your ENT. Even under updated guidelines, these specific water activities deserve extra care:
Diving and deep underwater submersion. Water pressure increases with depth. At greater depths, that pressure is more likely to drive water through the tubes into the middle ear. Jumping from a diving board, dive entries, and competitive diving should be discussed with your ENT specifically — many doctors recommend ear plugs or modified entries for these activities.
Forceful dunking in play. Pool games that involve forceful head submersion create rapid pressure changes that are more likely to allow water ingress. If your child is in a pool environment where dunking games happen, ear protection is a reasonable precaution.
Natural water — lakes, rivers, oceans. Unlike chlorinated pools, natural water bodies contain far higher bacterial loads. Water that enters the middle ear through the tubes from a lake or ocean carries a much higher infection risk. Most ENT physicians recommend ear plugs for swimming in untreated natural water when tubes are in place.
Bathtime. Baths generally don't create the pressure needed to drive water through tubes, but your child's ENT may have specific guidance — particularly for post-surgical recovery periods.
🔵 Do ear plugs help children with ear tubes?
When an ENT recommends ear plugs for specific situations, custom-molded or pre-molded silicone plugs work best, while standard foam plugs are not recommended. If your ENT recommends ear plugs for specific situations, choosing the right type matters.
For children with ear tubes, the most commonly recommended ear protection options are:
- Custom-molded silicone ear plugs made by an audiologist offer the best seal and are designed specifically for children's ear canals. They're the gold standard but the most expensive option.
- Pre-molded silicone swimming ear plugs (like Doc's ProPlugs or Mack's Silicone Putty) offer a good seal at a fraction of the cost. Look for putty-style plugs that conform to the outer ear rather than hard plugs that insert into the canal.
- Standard foam ear plugs are NOT recommended — they don't create a waterproof seal and can be difficult to remove from children's ears.
A swimmer's headband worn over the ears can help keep ear plugs in place during active swimming, especially for younger children.
Important: ear plugs for children should always be used under supervision to prevent them from being pushed too deeply into the ear canal. Your audiologist or ENT can demonstrate proper insertion technique.
🌡️ What are the signs of an ear infection after swimming?
Watch for ear pain or tugging, drainage from the ear canal, a "full" or muffled feeling, or fever within a day or two after swimming. Even with precautions, water can occasionally make its way through ear tubes. Knowing the signs of an infection means you can act quickly:
- Ear pain or tugging at the ear within 1–2 days after swimming
- Visible drainage or discharge from the ear canal (this is actually the tubes working — the fluid is draining out rather than building up)
- The child complains their ear feels "full" or their hearing seems muffled
- Fever in combination with ear symptoms
The good news: infections that occur through ear tubes are usually treated with antibiotic ear drops (not oral antibiotics), which are highly effective and much easier on a child's system. Contact your child's ENT or pediatrician if you notice any of these symptoms after a swim.
🏊 How do you keep your child in swim lessons?
Ensure ear-related restrictions don't create gaps in swim lesson attendance — keeping children in consistent lessons is a water safety priority. Drowning risk is real and ongoing, and the American Red Cross emphasizes learning to swim as a foundational safety skill for every child.
Talk to your child's swim instructor about their ear tube status. Most programs can easily accommodate children with ear tubes by:
- Modifying any diving or underwater activities per the doctor's guidance
- Ensuring the child wears ear protection when it's been recommended
- Adjusting in-water time to minimize prolonged submersion if needed
Most children with ear tubes can participate fully in swim lessons with only minor modifications during deep-water or submersion activities. The infection risk of controlled, chlorinated pool swimming is considered low enough by most ENTs that it should not prevent children from learning to swim safely — and the American Academy of Pediatrics encourages swim lessons as part of every child's layered water-safety plan.
⏰ What changes after the tubes fall out?
Ear tubes typically fall out on their own over 6–18 months, and once the eardrums heal and your ENT confirms it, swimming restrictions usually lift entirely. Ear tubes typically fall out over 6–18 months, and the small hole in the eardrum heals on its own in most cases. Once tubes have fully expelled and your ENT confirms the eardrums are healed, all swimming restrictions typically lift entirely.
If your child's tubes don't fall out on their own within the expected timeframe, a quick office procedure can remove them. Your ENT will monitor the situation at routine follow-up appointments.
After healing, some children — particularly those with a history of recurrent infections — may need a second set of tubes. Each round of tube placement comes with the same swimming guidance conversation with your ENT.
📚 Authoritative Sources
- American Academy of Pediatrics: swim lessons and layered water safety for children, even with medical considerations.
- American Red Cross — Swim Lessons: learning to swim as a foundational safety skill for every child.
- CDC — Drowning Facts: ongoing drowning risk that makes consistent swim-lesson attendance a priority.