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Is it safe to swim with grommets?

Q - How safe is post-operative swimming with grommets inserted?

A - This question can provoke conflicting responses. In a survey of British otolaryngologists, 14 per cent of the 301 respondents advised their patients not to swim and 66 per cent advised ear protection.

A similar survey involving 1,266 otolaryngologists in the US found a total ban was recommended by 13 per cent and some limit on the type and depth of swimming by the rest.

There is no published, randomised, controlled clinical trial that has examined the need for water precautions during swimming, but a recent meta-analysis of patients with grommets showed the rates of otorrhoea in swimmers regardless of ear protection ranged from 7 per cent to 68 per cent and in non-swimmers was 15 per cent to 60 per cent.

The small lumen of the grommet prevents water from easily entering the middle ear. It has been estimated between 12.8 and 22.8cm H2O pressure is needed for water to pass through a patent grommet and this amount of pressure is not found with surface swimming or ducking the head under the water.

Diving at greater depth can force water into the middle ear. Soapy bath water has a lower surface tension and may be contaminated with enteric organisms. At bathtime, children with grommets should keep their heads out of the water or wear ear plugs.

Patients with grommets should not abstain from swimming. Routine use of ear plugs is not justified but it is advisable for plugs to be used in patients for whom swimming involves diving below the surface.

Ms Jaan Panesar, specialist

registrar, and Mr Theo Joseph, consultant ENT Surgeon, Royal National Throat Nose and Ear Hospital, London

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