Tympanostomy tubes and water exposure: a practical model.
OBJECTIVE
To determine whether water exposure causes middle ear contamination in patients with collar button tympanostomy tubes (TTs).


METHODS
An in vitro model of a human head that contained an auricle, external auditory canal, tympanic membrane with TT, middle ear, eustachian tube, and mastoid cavity was developed. Two electrodes connected to an external ohmmeter resided in the middle ear to detect water entry. The model was tested with 4 types of water exposure: showering, bathing, hair rinsing, and swimming. Statistical analysis was performed by the Fisher exact test.


METHODS
A positive test result corresponded to water entering the middle ear via the TT, confirmed by a resistance reading of zero on the ohmmeter. A negative test result indicated no change in the initial high resistance reading.


RESULTS
No positive test results were obtained for showering (0 of 60 tests), hair rinsing (0 of 60 tests), or head submersion (12.7 cm) in clean tap water (0 of 60 tests). Ten positive test results were obtained for head submersion in soapy water (10 of 97 tests), which was statistically different from clean water (P< or =.007). Swimming pool depths of 30, 45, 60, and 75 cm elicited positive test results in 2 of 16, 3 of 18, 2 of 20, and 11 of 20 tests, respectively. A higher incidence of water entry into the middle ear occurred at depths of more than 60 cm (P< or =.001). No statistical difference between depths of 60 cm or less occurred (P= .88).


CONCLUSIONS
Showering, hair rinsing, and head submersion in clean tap water do not promote water entry into the middle ear. Submersion in soapy water increases the probability of water contamination. Pool water infrequently enters the middle ear with head submersion, but the incidence increases with deeper swimming (>60 cm). These data provide further evidence that many water precautions frequently advised in patients with TTs are unnecessary.
Hebert
R L
RL
Division of Otolaryngology, Medical College of Georgia, Augusta, USA. RLHII@msn.co
King
G E
GE
Bent
J P
JP
D000180:Acrylic Resins; D000328:Adult; D006257:Head; D006801:Humans; D006920:Hygiene; D007101:Immersion / Q000009:adverse effects*; D066298:In Vitro Techniques; D008876:Middle Ear Ventilation / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D008953:Models, Anatomic; D010033:Otitis Media / Q000150:complications / Q000601:surgery; D013550:Swimming
D000180:Acrylic Resins