Effect of Water Precautions on Otorrhea Incidence after Pediatric Tympanostomy Tube: Randomized Controlled Trial Evidence

Joao Subtil, Ana Jardim, João Araujo, Carla Moreira, Tiago Eµa, Merlin McMillan, Sara Simoes Dias, Paulo Vera Cruz, Richard Voegels, Joao Paço, Richard Rosenfeld

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7 Citations (Scopus)


Objectives: Tympanostomy with ventilation tube insertion is the most common otologic surgery. Many surgeons recommend water precautions, although its utility is questioned. We aimed to investigate if water precautions reduce the rate of otorrhea after transtympanic tube insertion. Study Design: Multicenter randomized controlled trial. Subjects and Methods: A total of 244 children aged 2 to 10 years undergoing their first set of Shepard tubes for otitis media with effusion and concomitant adenoidectomy were randomized to 2 groups: 1 with ear protection during water exposure (ear plugs and headbands, n = 130) and 1 without (n = 114). Bathing or swimming with unprotected ears was considered the exposure event and incidence of otorrhea, the primary outcome. Outcomes were assessed during the 6-month follow-up period. Results: In the water precaution group, 32% had at least 1 episode of otorrhea as compared with 22% in the unprotected group, which was not statistically significant (P =.09). Only 37% of the episodes of otorrhea in the protected group and 36% in the unprotected group had a temporal relation to water exposure (no difference, P =.81). Respectively, 56% and 52% of the episodes of otorrhea were in the context of upper respiratory tract infection. Global quality of life improved significantly, irrespective of whether water protection was prescribed. Conclusion: The incidence of otorrhea was not different with or without prescription of ear protection during water exposure among children with tympanostomy tubes, which supports current guideline recommendations that routine water precautions are unnecessary in this population.

Original languageEnglish
JournalOtolaryngology - Head and Neck Surgery (United States)
Publication statusPublished - 2019


  • middle ear ventilation
  • otitis media with effusion
  • postoperative care
  • swimming
  • water precautions


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