Grommets are small plastic or silicone tubes designed to allow air to enter the middle ear. They have a tiny central hole that is around 1mm in size. This hole may also allow the entry of water into the middle ear, which may result in the development of an infection.
Usually, the surface tension of the water prevents water passing through the hole and entering the middle ear, however soap can reduce this surface tension and allow water to pass through the hole. Water placed under pressure can also pass via a grommet and enter the middle ear. Once water reaches the middle ear it presents a risk for infection.
As grommets are not a natural part of the body, they can sometimes develop a film of bacteria known as a “biofilm” which resides on the grommet. This may lead to recurrent discharge from the ear.
Baths
Bath water includes all the dirt and grime from the day’s activity and is usually mixed with soap, which reduces water surface tension. As a result, bath water can pass through the hole in the grommet and enter the middle ear, perhaps leading to an infection. The chemicals in some soaps and shampoos may also be quite irritating to the middle ear.
A simple way to protect the ear from bath water is to smear some cotton wool with Vaseline and position this over the entrance to the ear canal during a bath. An alternative option is to use earplugs to protect the ear from the entry of water.
In cases where children refuse to use the above methods, bathing in fresh water without soaps is a reasonable alternative. Showers also tend to have less risk of water entry into the middle ear via the grommet.
Swimming
In the first 2 weeks after the placement of the grommet, the eardrum is still healing. During this time, it is best to avoid swimming.
Pool water is less likely to enter the middle ear via a grommet due to the surface tension of this water, even with submersion and shallow diving. Consequently, once the healing period is complete, it is usually safe to swim in a swimming pool or the ocean.
Ear Infections
Having a grommet in place does create a slightly higher risk of ear infection when exposed to water compared with people without grommets. Some people will develop an ear infection, or in some cases recurrent ear infections related to the grommets and water. When an infection occurs, there will usually be discharge from the ear and sometimes pain. The usual treatment involves eardrops and is best completed under the guidance of Dr Morrissey or your GP.
Preventing ear infections and grommets
Given a slightly increased risk of infection as mentioned above, Dr Morrissey recommends the following precautions to minimise the risk of ear infection with grommets:
Avoid swimming and submersion of the ears in the first 2 weeks after surgery.
Baths and Showers
- Wash hair in the shower if possible;
- Use ear plugs or Vaseline soaked cotton balls in the bath.
When Swimming
- All adults and children should use ear plugs or a head wrap / swimming cap if possible;
- Avoid Blu-tack and similar substances pushed into the ear canal, as they may not come out;
- Avoid diving as the pressure can force water into the middle ear;
- Avoid dirty water/waterholes/creeks and rivers as they can contain significant bacterial populations; and
- Be on the lookout for discharge from the ear, redness and pain as this could indicate an ear infection related to the grommet.
If water inadvertently gets into the ear, drying the ear with a warm hairdryer or tissue spear can reduce the risk of infection by minimising the time with water present in the ear.
