Water precautions after insertion of a tympanostomy tube: necessary or obsolete?

Introduction: Since the introduction of tympanostomy tubes by Armstrong in 1952, physicians and patients alike have been concerned about the possible harm associated with water entering the middle ear via tubes. It is the cur rent practice of many physicians to advise patients to avoid water entering the middle ear by using water precautions when swimming. However, the pote ntial harmful effect of water in causing otorrhoea and otalgia still remain s controversial. Materials and methods: A prospective study was performed analysing the effe ct of water exposure in patients with tympanostomy tubes, both those who do and those who do not take water precautions. Between January 1996 and Janu ary 1997, patients who had tympanostomy tubes inserted were assigned to one of two groups on the basis of parental preference. Group I consisted of ch ildren who were allowed to swim without water protection, while in group II the children were instructed to use water protection whenever swimming. On ce assigned, patients remained in that group. The parents were required to keep a diary documenting the number of days the child went swimming and exp erienced otorrhoea, otalgia or symptoms relating to an upper respiratory tr act infection. Of the 86 patients enrolled in the study, comprehensive foll ow-up information was available in 63 (47 children in group I and 16 in gro up II). Results: The mean period of follow-up was 8 months. The incidence of otorrh oea/otalgia after swimming was 36% in group I and 25% in group II. The diff erence between the two groups was not statistically significant (p = 0.33). The symptoms of otorrhoea and otalgia were of short duration and self-limi ting in the vast majority of the patients. It was necessary to remove the t ympanostomy tube in only one patient. Conclusions: In patients with tympanostomy tubes swimming without water pre caution does not predispose to otorrhoea. On the basis of this study, previ ous investigations using in vitro models, and the literature, it is current ly our practice to permit children to swim without water precautions two we eks after insertion of a tympanostomy tube.