By Gabriel J. Tsao MD and Richard L. Goode MD, from The Laryngoscope
Triological Society Best Practice
Tympanostomy tube insertion is one of the most commonly performed pediatric procedures in the United States. In an effort to reduce the incidence of postoperative otorrhea, many surgeons have traditionally recommended strict avoidance of water exposure to the ears. A number of studies have questioned the efficacy of such recommendations. Tsao and Goode examined the evidence regarding water precautions and post-tympanostomy tube otorrhea.
Articles were identified through an English language MEDLINE search using text words “water precautions,” “swimming,” “tympanostomy tubes,” “myringotomy,” and “ear tubes.” Abstracts, and if necessary complete manuscripts, were reviewed for relevancy and level of evidence.
In a prospective cohort study from 1996, Salata and Derkay followed 543 patients after tympanostomy tube placement. To improve compliance, the patients’ parents were allowed to self-select into three treatment groups: group 1 (no swimming precautions given); group 2 (antibiotic ear drops administered prophylactically after swimming); and group 3 (swimming with ear molds). Additionally, there was a fourth group including children who were preassigned to a group but did not swim during the study period. This study addressed a variety of related factors including frequency of head dunking; the rates of otorrhea related to swimming, upper respiratory infections, and bathing; and the location of swimming (outdoor pool, indoor pool, ocean, lake, and river). No significant differences were noted in the rates of otorrhea by group, or in relation to any of the subgroups. However, there was a trend toward increased otorrhea in patients who swam in lakes and as the frequency of head dunking increased, though these were not statistically significant.
Water precautions should not be routinely advised after tympanostomy tube placement.
LEVEL OF EVIDENCE
Studies included in this manuscript are of evidence level 1b (an individual randomized controlled trial), 2a (systemic reviews of cohort studies), and 2b (individual cohort study).
1 Salata JA, Derkay CS. Water precautions in children with tympanostomy tubes. Arch Otolaryngol Head Neck Surg 1996;122:276–280.
2 Lee D, Youk A, Goldstein NA. A meta-analysis of swimming and water precautions. Laryngoscope 1999;109:536–540.
3 Carbonell R, Ruiz-Garcia V. Ventilation tubes after surgery for otitis media with effusion or acute otitis media and swimming. Systematic review and meta-analysis. Int J Pediatr Otolrhinolaryngol 2002;66:281–289.
4 Goldstein NA, Mandel EM, Kurs-Lasky M, Rockette HE, Casselbrant ML. Water precautions and tympanostomy tubes: a randomized, controlled trial. Laryngoscope 2005;115:324–330.
5 Pashley NRT, Scholl PD. Tympanostomy tubes and liquids: an in vitro study. J Otolaryngol 1984;13:296–298.
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