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.

Does calcemia influence the onset of myringosclerosis after myringotomy with the insertion of ventilation tubes?

INTRODUCTION: Myringosclerosis is one of the most frequent late complications of the insertion of ventilation tubes, and its aetiopathogenesis remains unknown. The calcification that occurs in the formation of myringosclerosis plaque raises the hypothesis of the presence of a calcium metabolism disorder. The objective is to determine whether calcemia contributes to the development of myringoscelerosis after insertion of ventilation tubes. MATERIAL AND METHODS: A longitudinal, prospective, analytical cohort study was conducted in patients undergoing myringotomy with the insertion of ventilation tubes due to otitis media with effusion. Calcemia was evaluated pre-operatively and in the follow-up the appearance of myringosclerosis and the percentage of the tympanum involved were evaluated. RESULTS: The study included 156 patients (297 ears), with calcemia values ranging from 7.6 to 10.2mg/dl. Myringosclerosis was identified in 35.4% of the operated ears. No relationship was found between the appearance of myringosclerosis and calcemia (p=.596). It was found, however, that the greater the percentage of the tympanum affected by myringosclerosis, the lower the calcemia values (p=.014). CONCLUSION: The population studied had calcemia values within the normal range, which allows us to infer that no changes in calcium metabolism are required for the development of myringosclerosis. Moreover, unlike in previous studies, higher calcium levels are not associated with more myringosclerosis. Calcemia did not influence the appearance of myringosclerosis after myringotomy with the insertion of ventilation tubes.

Otitis media con efusión en pacientes con fisura palatina: comparación de estrategias terapéuticas / Otitis media with effusion in patients with cleft palate: comparison of treatment strategies

Introducción: La otitis media con efusión presenta una alta prevalencia en pacientes con fisura palatina, debido a una obstrucción funcional de la tuba auditiva. Dada su asociación con hipoacusia y una baja tendencia de resolución espontánea, existe controversia sobre la necesidad de instalar tubos de ventilación en estos pacientes. Objetivo: Comparar resultados anatómicos y audiológicos de dos estrategias de tratamiento. Material y método: Estudio de cohorte histórica en niños de 8 a 11 años con fisura velopalatina operada. La otitis con efusión de un grupo se trató con tubos de ventilación, mientras otro grupo tuvo un manejo conservador. La presencia de alteraciones timpánicas e hipoacusia se compararon entre ambos grupos mediante Xi cuadrado y test de Fischer. Resultados: Cincuenta y seis pacientes fueron reclutados, 24 en estrategia quirúrgica y 32 en conservadora. Todos los pacientes presentan una evaluación fonoaudiológica normal. Existe mayor frecuencia de retracción timpánica, perforación timpánica e hipoacusia de conducción en aquellos niños sometidos a una estrategia agresiva de tratamiento. Discusión: Existen mayores alteraciones timpánicas e hipoacusia en los pacientes sometidos a una estrategia de tratamiento quirúrgica, por lo que parece prudente realizar una evaluación individual y determinar la necesidad de cirugía de acuerdo a cada paciente.

Introduction: Otitis media with effusion (OME) is a frequent finding in patients with cleft palate due to a functional obstruction of the Eustachian tube. Because of its association with hearing loss and low rate of spontaneous resolution the use of ventilation tubes as treatment appears as beneficial The clinical and audiological consequences of this conduct areinot well established. Aim: To compare anatómical and audiologics results with two strategies of treatment. Material ana method: Historical cohort study of children from 8 to 10 years, with cleft palate, surgically corrected, and with OME. One group was treated with ventilation tubes, and an expectant management was carried out with the other group. The following parameters were compared by Xi-square test and Fischer: tympanic membrane state, presence of compiications and hearing level. Results: Fifty six patients were admitted, 24 in surgical management and 32 in conservative. Every child had a cleft palate corrected without velopharyngeal insufficiency It was found a higher frequency of tympanic membrane retraction, tympanic membrane perforation and hearing loss in the case groups were found. Discusion: We found a greater presence of tympanic alterations and hearing disorders in patients subjected to ventilation tubes as treatment of OME. It seems prudent to evalúate the surgical alternative individually according to each patient characteristic.