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Outcomes and Characteristics of Water Exposure in Children with Tympanostomy Tubes
Alexandria L Irace1, Terri Giordano2, Ashley Williams2
1Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Insights
Exposure to untreated water increases the risk of recurrent tympanostomy tube otorrhea (TTO) in children after tympanostomy tube placement (TTP). Swimming in treated pools is safe, suggesting personalized water precautions are best.
Area of Science:
- Pediatric Otolaryngology
- Infectious Disease Prevention
Background:
- Tympanostomy tube placement (TTP) is common in children.
- Tympanostomy tube otorrhea (TTO) is a frequent complication.
- Understanding water exposure risks is crucial for preventing TTO.
Purpose of the Study:
- To investigate the association between specific water exposure types and TTO incidence.
- To differentiate risks associated with untreated vs. treated water sources.
Main Methods:
- Cross-sectional survey of 137 caregivers of children with prior TTP.
- Corroboration of survey data with medical chart review.
- Multivariable logistic regression to analyze water exposure (untreated vs. treated) and recurrent TTO risk.
Main Results:
- Nearly 50% of patients experienced recurrent TTO.
- Exposure to untreated "dirty" water (ocean, lake, untreated pools) significantly increased TTO odds (OR 3.18, P=.009).
- Exposure to treated "clean" water (chlorinated/salt pools) showed no significant association with TTO.
Conclusions:
- Untreated water sources are linked to higher recurrent TTO risk post-TTP.
- Treated pool water appears safe for children with tympanostomy tubes.
- Individualized water precaution counseling is recommended over universal restrictions.
Objective:
To investigate the association between specific types of water exposure and the incidence of tympanostomy tube otorrhea (TTO) in pediatric patients following tympanostomy tube placement (TTP).
Study Designs:
Cross-sectional survey.
Setting:
Tertiary pediatric otolaryngology practice.
Methods:
Caregivers of children who had undergone TTP at least 6 months prior were surveyed regarding their child's water exposure habits and episodes of otorrhea since surgery. Survey data were corroborated with medical chart review. Multivariable logistic regression was used to evaluate associations between exposure to "dirty" water (ocean, lake, or untreated pool water) versus "clean" water (chlorinated or salt-treated pool water) and the risk of recurrent TTO.
Results:
Caregivers of 137 eligible patients completed the survey, and 68 (49.6%) reported recurrent TTO. Adjusting for age, smoke exposure, and other potential confounders, patients exposed to dirty water had 3.18 times higher odds of developing recurrent TTO compared to patients not exposed to dirty water (95% confidence interval [CI] 1.33-7.62, P = .009), while no significant association was observed between clean water exposure and TTO. Similar findings were observed when comparing patients with 0 versus ≥1 episode of TTO and <2 versus ≥2 episodes of TTO.
Conclusion:
Exposure to untreated or natural water sources may be associated with an increased likelihood of recurrent otorrhea following TTP, while swimming in treated pools appears safe. These findings support individualized water precaution counseling rather than universal restrictions, and further research is warranted to clarify underlying biological mechanisms and modifiable risk factors.
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