Aural Water Protection Makes No Difference Among Children With Tympanostomy Tubes

by Amy E. Hamaker •

Do water precautions reduce the rate of otorrhea after transtympanic tube insertion?

Bottom Line: Otorrhea incidence was not different with or without ear protection during water exposure among children with tympanostomy tubes.

Background: Although upper respiratory tract infections (URTIs) are a frequent cause of otorrhea after transtympanic tube insertion, water penetration has been implicated. There is mounting evidence that water does not traverse tympanostomy tubes unless under significant pressure, but water precautions are still frequently recommended.   

Commentary: “This multicenter, randomized controlled trial evaluated 244 children for otorrhea after pressure equalization tube insertion. Subjects were randomized to use ear plugs and headbands during water exposure versus no special precautions. Routine water precautions were noted to be unnecessary in preventing otorrhea.” —Cristina Cabrera-Muffly, MD

Study design: A multicenter, randomized controlled trial of 244 children aged two to 10 years undergoing their first set of Shepard tubes for otitis media with effusion and concomitant adenoidectomy between February 2015 and August 2017. The children were randomized into two groups: ear protection (ear plugs and headbands, n = 130) and unprotected (n = 114). 

Setting: Hospital Cuf Descobertas, Hospital Beatriz Angelo, Hospital D. Estefania, and Hospital Santa Maria, all in Lisbon, Portugal.

Synopsis: Cumulative otorrhea incidence was 27% (32% ear protection; 22% unprotected). Sixteen participants had two episodes (10 with ear protection, six unprotected), and two unprotected patients had three episodes; no factor was associated with multiple episodes. In 24 otorrhea episodes (15 with ear protection, nine unprotected), parents described a temporal relation with more substantial water exposure, such as diving deeper, swimming longer, or head submersion in bathwater. Swimming participation was not associated with a higher otorrhea incidence in either group, and ear protection was not associated with an otorrhea rate difference between swimmers and nonswimmers. The global cumulative incidence of URTIs was 36.9%, with no significant difference between groups, and no risk factor was associated with higher URTI incidence. Both the unprotected and ear protection groups improved from 84% to 87% in quality of life scores. Limitations included multiple P value concerns due to a bivariate analysis of multiple risk factors, the small number of multiple otorrhea episodes, and results that may be applicable only for larger tube sizes. 

Citation: Subtil J, Jardim A, Araujo J, et al. Effect of water precautions on otorrhea incidence after pediatric tympanostomy tube: Randomized controlled trial evidence. Otolaryngol Head Neck Surg. 2019;161:514–521.