Do grommets equal ear plugs?
There is new evidence about the need to keep ears dry for children who have grommets inserted.
What are grommets?
"Grommets" are middle ear ventilation tubes inserted surgically into a child's middle ear to allow fresh air in. They are known by a number of names (eg ventilation tubes, drainage tubes, Shepard’s tubes, Collar button tubes and T- tubes). They are sometimes used for conditions such as 'glue ear' where the liquid produced by the middle ear becomes 'glue- like' or 'gluggy' and this can create a hearing impairment, difficulties with balance or feeling irritable. The official names for this condition are "Otitis Media with Effusion" or "Mucoid Otitis Media". (Important side note: 'glue - ear' does not always need treatment.)
What do the specialists say about grommets and water?
Ear, nose and throat (ENT) surgeons are the specialists who look after assessment and treatment of conditions like 'glue - ear'.
There is huge variation between what ENT specialists recommend for children with grommets. Some permit swimming and bathing, and others recommend use of ear plugs for both while the grommets are in place, to prevent ear infections. I've hard both of these recommendations from ENTs:
"I can cure an ear infection but I can't cure drowning, so go and swim"
"Never get your child's ears wet, even in the bath, unless you have good fitting ear plugs in place".
So this has been confusing for parents and clinicians alike!
In light of this, the latest Aquatic Physiotherapy Guidelines, released by the Australian Physiotherapy Association in 2015, noted grommets as something to be considered in planning participation in aquatic physiotherapy, but not as a contraindication.
What is the latest evidence about the need to keep ears dry if a child has grommets?
The Cochrane Ear Nose and Throat team has done a systematic review asking: does keeping ears dry prevent ear infections for children with grommets?
A systematic review is the highest level of scientific evidence. This one included randomised controlled trials of children aged 0 to 17 years with ventilation tubes (grommets), that assessed the effect of water precautions while the tubes are in place. Water precaution included physical precautions (eg ear plugs and hats or head bands) and behavioural precautions (eg avoiding water, or not swimming or allowing water over the ears at bathtime).
They found that:
"The difference that wearing ear plugs makes appears to be very small and a child would have to wear them on average for almost three years to prevent one infection resulting in ear discharge."
and
"Current expert guidelines for clinicians therefore recommend against routinely using water precautions because the limited clinical benefit is outweighed by the associated cost, inconvenience, and anxiety."
Lead author of the Cochrane review, Daniel Moualed, says:
"Specifically with this review, it can provide peace of mind to parents to let their kids get their ears wet when swimming or bathing."
In light of this review, we recommend familes of children with grommets consider this information in discussion with their doctors to make an informed choice about whether to use ear plugs.
It is important that we keep up to date with the latest scientific evidence so that we can continue to update our clinical practice and recommendations.
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Shayna Gavin is a physiotherapist who is passionate about helping babies, children and young people learn functional skills so they can participate in life at home, school and in their community. Recognising that children do best in their own environments, she visits homes, schools, and leisure activities from football fields to ballet classes. She also has daily aquatic physiotherapy sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne. She combines principles of paediatric physiotherapy, Neuro Developmental Treatment / Bobath, motor learning, Sensory Integration and swimming teaching to address the individual needs of each child and their family. She loves providing professional development to physiotherapists, allied health and education professionals, allied health assistants and swimming teachers.
