Swimming and ear infection

A meta-analysis of swimming and water precautions

OBJECTIVE

To reconcile conflicting reports concerning the incidence of otorrhea in children with tympanostomy tubes who swim without ear protection.

STUDY SELECTION

Articles were identified by MEDLINE search, Current Contents, and references from review articles, textbook chapters, and retrieved reports. Controlled trials of water precautions following tympanostomy tube placement were selected by independent observers and scored on 10 measures of study validity. Five English-language articles met all inclusion criteria.

DATA EXTRACTION

Data were abstracted for an endpoint of otorrhea following swimming without ear protection with a minimum follow-up of 6 weeks.

DATA SYNTHESIS

Pooled analysis of 619 children revealed a rate difference of -5.04 (95% confidence interval [CI], -11.62 to 1.54). No significant difference in the incidence of otorrhea was noted between patients who swam without ear protection and nonswimmers.

CONCLUSION

There is no increase in incidence of otorrhea in children who swim without ear protection compared with children who do not swim following tympanostomy tube placement.

Grommets, swimming and otorrhoea--a review

Ever since Armstrong reintroduced the concept of grommet insertion parents have been asking 'may my child swim?', yet there is still no consensus as to the correct answer. This paper reviews the work that has been done on this subject in the last 25 years. A review of the rates of otorrhoea following grommet insertion, irrespective of swimming, shows a variation from 12 to 64 per cent. Evidence suggests that pressures of 12-23 cm H2O are needed to push water through a grommet and that it is unlikely that water will enter the middle ear during surface swimming. Only bath water seems to cause significant inflammatory changes to middle ear mucosa. Not a single paper comparing swimmers with non-swimmers shows an increased rate of otorrhoea in those patients who swam; to the contrary, rates of otorrhoea were repeatedly higher in those patients who did not swim. The evidence suggests that swimming without ear protection can be safely permitted for children with grommets.