WATER PRECAUTIONS AND TYMPANOSTOMY TUBES

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Children with tympanostomy tubes have traditionally been advised to protect their ears when swimming and bathing. Although acute otorrhea through a patent tube is a common occurrence, there is no published evidence that water exposure is causative. We will prospectively randomize 300 children, ages 6 months to 6 years, who have had bilateral tympanostomy tubes placed within one month of entry to one of 2 groups: 1) swimming and bathing without earplugs or 2) swimming and bathing with earplugs. We will stratify the groups by age (<4 years, > 4 years) and by diagnosis (recurrent acute otitis media, otitis media with effusion). Parents will be given a calendar to record all swimming and bathing activity. The children will be seen monthly for one year, and whenever there is an intercurrent ear, nose, or throat problem. If otorrhea develops, a culture will be performed and the child will be treated with an oral antibiotic and ototopical drops. The primary comparison will be the incidence of otorrhea in each experimental group and the second comparison will be the average number of episodes per child in the two groups. Examination of the culture results will help determine the pathogenic mechanisms responsible for the otorrhea.