Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence - retrospective cohort study

Abstract Introduction Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective To understand the benefit of this recommendation. Methods Observational study - retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51-2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.

【摘要】鼓膜切开置管术（myringotomy for tube insertion）是最常见的耳科手术（otologic surgery）。耳漏（otorrhea）是该术式的常见并发症，为预防该并发症，多数外科医生强烈建议患者术后避免接触水源，因学界普遍认为接触水源会对术后生活质量产生负面影响。本研究旨在明确该推荐建议的实际获益。
研究方法：本研究为观察性回顾性队列研究，纳入2011年5月至2012年5月期间因慢性分泌性中耳炎（chronic otitis media with effusion）接受双侧鼓膜切开置管术的10岁以下儿童患者，分为两组：一组术后接受防水护理，另一组未采取相关防护措施。术后随访满1年时，通过电话访谈收集相关数据，将未采取防护措施的水源暴露设为暴露因素，以耳漏发生率及其对患者生活质量的主观影响作为主要结局指标，经逻辑回归（logistic regression）分析后比较两组差异。
研究结果：本研究共纳入143例儿童患者，其中未采取水源暴露防护者116例，采取防护措施者27例。未防护组中36.2%的患儿至少发生过1次耳漏，防护组为40.0%；暴露组耳漏的比值比（odds ratio）为1.21（95%置信区间0.51~2.85，P=0.6）。患儿家长报告显示，未防护组48.2%的儿童生活质量受到负面影响，防护组为40.7%，该差异无统计学意义（P=0.5）。
研究结论：本研究发现，针对慢性分泌性中耳炎行鼓膜切开置管术的患者，推荐术后防水护理并未降低耳漏的发生率，且该措施亦未对患者生活质量产生负面影响。本研究为小样本人群观察性研究（共纳入143例患者），上述结论尚需通过开展大样本量且设置大型对照组的人群研究进一步验证。