Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial

Miyake, Marcel M.; Tateno, Daniela Akemi; Cançado, Natália Amaral; Miyake, Michelle Menon; Tincani, Stefano; Neto, Osmar Mesquita de Sousa

doi:10.31744/einstein_journal/2019ao4423

Cited by 6 publications

(5 citation statements)

References 13 publications

(22 reference statements)

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“…Similarly, Miyake et al randomized 80 children with tympanostomy tubes to “protection” with ear plugs and advice not to swim versus no ear plugs or swimming restrictions. Despite a small reduction in otorrhea with ear plugs in only the first postoperative month, there were no differences between the groups during months 2 to 13 after surgery 235 …”

Section: Guideline Key Action Statementsmentioning

confidence: 70%

“…Despite a small reduction in otorrhea with ear plugs in only the first postoperative month, there were no differences between the groups during months 2 to 13 after surgery. 235…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

“…Water precautions with consistent use of ear plugs are unnecessary for most children with tympanostomy tubes. [235][236][237] However, water precautions may be implemented for children during an episode of acute TTO, if the child is prone to recurrent acute TTO, or if the child has transient discomfort upon exposure to water during swimming, diving, or hair washing. 238 Importance of Perioperative Education.…”

Section: Action Statement Profilementioning

confidence: 99%

“…Despite a small reduction in otorrhea with ear plugs in only the first postoperative month, there were no differences between the groups during months 2 to 13 after surgery. 235 Two systematic reviews published after the 2013 guideline found no benefits for routine water precautions in children with tympanostomy tubes, but these were conducted prior to the RCTs cited in the prior paragraph. The first, a Cochrane review published in 2016, found no benefit for ear plugs after tympanostomy tube placement and suggested that additional research would best focus on identifying groups of children who might benefit from such intervention.…”

Section: Action Statement Profilementioning

confidence: 99%

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Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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Objective Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. Purpose The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. Methods In developing this update, the methods outlined in the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action” were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Statements The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude. The GUG made recommendations for the following KASs: (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months’ duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.

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Section: Guideline Key Action Statementsmentioning

confidence: 70%

“…Despite a small reduction in otorrhea with ear plugs in only the first postoperative month, there were no differences between the groups during months 2 to 13 after surgery. 235…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Section: Action Statement Profilementioning

confidence: 99%

Section: Action Statement Profilementioning

confidence: 99%

See 2 more Smart Citations

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

View full text Add to dashboard Cite

show abstract

“…In one study comparing auricular protection versus no protection, patients who had protection had a reduced risk of otorrhoea in the first month, but this equalised between groups after the first post-operative month. 3 In a similarly designed study, otorrhoea was only found to be related to water exposure in 37 per cent of the water precaution group and in 36 per cent in the non-protected group; moreover, 56 per cent and 52 per cent of cases, respectively, were in the context of upper respiratory tract infections. 4 It would therefore appear that water penetration does not influence the occurrence of otorrhoea following grommet insertion.…”

Section: Discussionmentioning

confidence: 91%

Submersion with grommets: contamination is possible at minimal depth, as demonstrated with a novel middle-ear model

et al. 2022

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Objective Advice to patients following grommet insertion and waterproofing can vary from clinician to clinician. A laboratory based experiment was performed to determine at what depth water contamination would occur through various grommet tubes. Methods A novel experimental ear model was developed using an artificial tympanic membrane and ventilation tubes. Water contamination was identified using an effervescent solid that reacts when in contact with water. Measures of dispersion were used to describe the results. Results The average depth of water contamination was: 19.64 mm (range = 11–33 mm, standard deviation = 5.55 mm) using a Shepard grommet; 20.84 mm (range = 18–26 mm, standard deviation = 1.97 mm) with a titanium grommet; and 21.36 mm (range = 18–33 mm, standard deviation = 3.03 mm) using a T-tube. Water contamination was possible at depths of 11–33 mm. The average pressure at water effervescent activation was 0.20 kPa. Conclusion Submersion underwater at any depth with grommets is likely to lead to middle-ear contamination. These findings are concordant with clinical studies.

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Managing Risk Factors in Otitis Media

Stramielo,

Carvalho

2023

Textbook of Otitis Media

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Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial

Cited by 6 publications

References 13 publications

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Submersion with grommets: contamination is possible at minimal depth, as demonstrated with a novel middle-ear model

Managing Risk Factors in Otitis Media

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