Water protection in paediatric patients with ventilation tubes: Myth or reality? A systematic review.

BACKGROUND: Myringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs. METHODS: Two independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs. RESULTS: Four randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. The decision to protect the ear when exposed to water should be individualized and protection should be recommended during the first month after surgery and in cases of recurrent otorrhoea. CONCLUSION: Based on the literature available, allowing water surface activities with no ear protection seems to present a minimum risk, so it is not necessary to prohibit patients from swimming. However, some recommendations should be followed.

Water protection in paediatric patients with ventilation tubes: Myth or reality? A systematic review

BackgroundMyringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs.MethodsTwo independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs.ResultsFour randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. (AU)

AntecedentesLa miringotomía acompañada de la inserción de tubos de ventilación (TV) es uno de los procedimientos más realizados en niños y adolecentes a nivel mundial. Los TV normalmente permanecen sobre la membrana timpánica entre 6 y 12 meses, y durante este periodo una de las complicaciones más frecuentes es la presencia de otorrea. Durante muchos años, se les ha indicado a los padres la necesidad de evitar el contacto con agua de aquellos niños que tienen TV, ya que la exposición al agua puede producir otitis media aguda. Sin embargo, existe una creciente evidencia sobre la imposibilidad de que el agua pueda penetrar a través del TV a menos que exista una presión significativa y, por lo tanto, estas precauciones resultan innecesarias. A pesar de estas recomendaciones, muchos otorrinolaringólogos y pediatras siguen indicando tapones de oídos durante el baño o la natación e incluso la prohibición de deportes acuáticos. Actualmente en la literatura existen 2 revisiones sobre este tema: la primera utilizó criterios de selección estrictos e incluyó 2 estudios de alta calidad, mientras que la segunda presentó evidencia solo hasta el año 2005. El objetivo de esta revisión es identificar, resumir y evaluar críticamente la evidencia actual sobre las precauciones con el agua en los niños con TV.MétodosSe realizó un análisis de síntesis cualitativa tomando en cuenta los estudios seleccionados sobre los efectos de la exposición al agua en niños con TV.ResultadosSe incluyeron 4 ensayos clínicos aleatorizados y 5 estudios de cohortes prospectivos para un total de 1.299 pacientes con edades comprendidas entre los 3 meses y los 14 años. No se encontró una diferencia estadísticamente significativa en la incidencia de otorrea entre la exposición al agua con y sin tapones para los oídos en niños con TV, ni entre la exposición al agua y la no exposición al agua en niños con TV. (AU)

Water protection in paediatric patients with ventilation tubes: Myth or reality? A systematic review.

BACKGROUND: Myringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs. METHODS: Two independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs. RESULTS: Four randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. The decision to protect the ear when exposed to water should be individualized and protection should be recommended during the first month after surgery and in cases of recurrent otorrhoea. CONCLUSION: Based on the literature available, allowing water surface activities with no ear protection seems to present a minimum risk, so it is not necessary to prohibit patients from swimming. However, some recommendations should be followed.