Outcomes and Characteristics of Water Exposure in Children with Tympanostomy Tubes

TL;DR

Exposure to untreated water increases the risk of ear infections in children with ear tubes, while treated pool water is safer.

Contribution

This study identifies a specific association between 'dirty' water exposure and recurrent ear infections in children with tympanostomy tubes.

Findings

Exposure to 'dirty' water increases odds of recurrent TTO by 3.18 times.

Clean water exposure does not significantly increase TTO risk.

Findings suggest individualized water precautions rather than universal restrictions.

Abstract

To investigate the association between specific types of water exposure and the incidence of tympanostomy tube otorrhea (TTO) in pediatric patients following tympanostomy tube placement (TTP).

Cross‐sectional survey.

Tertiary pediatric otolaryngology practice.

Caregivers of children who had undergone TTP at least 6 months prior were surveyed regarding their child's water exposure habits and episodes of otorrhea since surgery. Survey data were corroborated with medical chart review. Multivariable logistic regression was used to evaluate associations between exposure to “dirty” water (ocean, lake, or untreated pool water) versus “clean” water (chlorinated or salt‐treated pool water) and the risk of recurrent TTO.

Caregivers of 137 eligible patients completed the survey, and 68 (49.6%) reported recurrent TTO. Adjusting for age, smoke exposure, and other potential confounders, patients exposed to dirty water had 3.18 times higher odds of developing recurrent TTO compared to patients not exposed to dirty water (95% confidence interval [CI] 1.33‐7.62, P = .009), while no significant association was observed between clean water exposure and TTO. Similar findings were observed when comparing patients with 0 versus ≥1 episode of TTO and <2 versus ≥2 episodes of TTO.

Exposure to untreated or natural water sources may be associated with an increased likelihood of recurrent otorrhea following TTP, while swimming in treated pools appears safe. These findings support individualized water precaution counseling rather than universal restrictions, and further research is warranted to clarify underlying biological mechanisms and modifiable risk factors.