Clinical question
Compared with controls, how effective are water precautions (ear plugs, water avoidance) for the prevention of ear infections in children with grommets?
Bottom line
The difference that wearing ear plugs makes appeared to be very small, and a child would have to wear them on average for almost 3 years to prevent 1 infection resulting in ear discharge. There was no difference in the likelihood of children getting ear infections whether they were told to avoid swimming and putting their head under water, or whether they took no precautions at all. No harm to any participant was reported in either study. Current expert guidelines for clinicians therefore recommend against routinely using water precautions because the limited clinical benefit is outweighed by the associated cost, inconvenience and anxiety.
Caveat
The quality of evidence for the use of ear plugs was graded as low, and that relating to water avoidance as very low. Neither study showed any other important differences between the children who got their ears wet and those who kept them dry. There was no effect on how long the tubes stayed in place or on hearing (although these results were only measured in 1 study).
Context
Ventilation tubes are used to treat hearing loss due to glue ear, or to treat recurrent ear infections. Most surgeons agree children's ears should be kept dry for a few weeks after the operation, but not all agree on whether ears need to be kept dry thereafter. Some surgeons allow children to swim and bathe without ear protection, whereas others recommend ears be kept dry while tubes are in place.
Cochrane Systematic Review
Moualed D et al. Water precautions for prevention of infection in children with ventilation tubes (grommets). Cochrane Reviews, 2016, Issue 1. Art. No.: CD010375.DOI: 10.1002/14651858. CD010375.pub2. This review contains 2 studies involving 413 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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