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

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 current practice of many physicians to advise patients to avoid water entering the middle ear by using water precautions when swimming. However, the potential harmful effect of water in causing otorrhoea and otalgia still remains controversial.

A prospective study was performed analysing the effect of water exposure in patients with tympanostomy tubes, both those who do and those who do not take water precautions. Between January 1996 and January 1997, patients who had tympanostomy tubes inserted were assigned to one of two groups on the basis of parental preference. Group I consisted of children who were allowed to swim without water protection, while in group II the children were instructed to use water protection whenever swimming. Once assigned, patients remained in that group. The parents were required to keep a diary documenting the number of days the child went swimming and experienced otorrhoea, otalgia or symptoms relating to an upper respiratory tract infection. Of the 86 patients enrolled in the study, comprehensive follow-up information was available in 63 (47 children in group I and 16 in group II).

The mean period of follow-up was 8 months. The incidence of otorrhoea/otalgia after swimming was 36% in group I and 25% in group II. The difference between the two groups was not statistically significant (p = 0.39). The symptoms of otorrhoea and otalgia were of short duration and self-limiting in the vast majority of the patients. It was necessary to remove the tympanostomy tube in only one patient.

In patients with tympanostomy tubes swimming without water precaution does not predispose to otorrhoea. On the basis of this study, previous investigations using in vitro models, and the literature, it is currently our practice to permit children to swim without water precautions two weeks after insertion of a tympanostomy tube.