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Published on: February 5, 2019
Impact of swimming on chronic suppurative otitis media in Aboriginal children: a randomised controlled trial
Anna T N Stephen1, Amanda J Leach, Peter S Morris
1Child Health Division, Menzies School of Health Research, Royal Darwin Hospital, Darwin, NT, Australia. anna.stephen@menzies.edu.au
Insights
Daily swimming lessons for Aboriginal children with ear conditions did not significantly reduce ear discharge or alter middle ear and nasopharyngeal bacteria. However, swimming is safe and should be encouraged for its other benefits.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Chronic suppurative otitis media is a significant health issue in Aboriginal children.
- Tympanic membrane perforations (TMP) are common in this population.
- The role of water exposure, like swimming, in ear health is not fully understood.
Purpose of the Study:
- To evaluate the effect of daily swimming on ear discharge rates in Aboriginal children with TMP.
- To assess changes in nasopharyngeal and middle ear microbiology following swimming interventions.
- To determine the safety and impact of swimming on ear health in this vulnerable group.
Main Methods:
- A randomized controlled trial was conducted with 89 Aboriginal children aged 5-12 years with TMP.
- Participants received 4 weeks of daily swimming lessons in a chlorinated pool.
- Outcomes measured included proportions of children with ear discharge and bacterial presence in the nasopharynx and middle ear.
Main Results:
- No statistically significant difference in ear discharge rates was observed between swimmers and non-swimmers after 4 weeks.
- Swimming did not lead to significant changes in the microbiology of the nasopharynx or middle ear.
- Dominant bacteria identified included Streptococcus pneumoniae, non-typeable Haemophilus influenzae, Staphylococcus aureus, and Pseudomonas aeruginosa.
Conclusions:
- Daily swimming lessons are unlikely to substantially reduce chronic suppurative otitis media or associated bacteria in this population.
- Swimming was not associated with an increased risk of ear discharge.
- Swimming interventions can be supported for Aboriginal children without discouraging participation due to ear health concerns.
Objectives:
To measure the impact of 4 weeks of daily swimming on rates of ear discharge among Aboriginal children with a tympanic membrane perforation (TMP) and on the microbiology of the nasopharynx and middle ear.
Design, Setting And Participants:
A randomised controlled trial involving 89 Aboriginal children (aged 5-12 2013s) with a TMP, conducted in two remote Northern Territory Aboriginal communities from August to December 2009.
Intervention:
4 school weeks of daily swimming lessons (45 minutes) in a chlorinated pool.
Main Outcome Measures:
Proportions of children with ear discharge and respiratory and opportunistic bacteria in the nasopharynx and middle ear.
Results:
Of 89 children randomly assigned to the swimming or non-swimming groups, 58 (26/41 swimmers and 32/48 non-swimmers) had ear discharge at baseline. After 4 weeks, 24 of 41 swimmers had ear discharge compared with 32 of 48 non-swimmers (risk difference, - 8% (95% CI, - 28% to 12%). There were no statistically significant changes in the microbiology of the nasopharynx or middle ear in swimmers or non-swimmers. Streptococcus pneumoniae and non-typeable Haemophilus influenzae were the dominant organisms cultured from the nasopharynx, and H. influenzae, Staphylococcus aureus and Pseudomonas aeruginosa were the dominant organisms in the middle ear.
Conclusions:
Swimming lessons for Aboriginal children in remote communities should be supported, but it is unlikely that they will substantially reduce rates of chronic suppurative otitis media and associated bacteria in the nasopharynx and middle ear. However, swimming was not associated with increased risk of ear discharge and we found no reason to discourage it.
Trial Registration:
Australian New Zealand Clinical Trials Registry ACTRN12613000634774.