For a prospective, randomized, controlled trial 1 201 children (age range 6 months to 6 years), who had undergone bilateral myringotomy and tube insertion, were randomized into groups of swimming and bathing with or without ear plugs. Mean duration of follow-up was 9.4 months for the children with ear plugs and 9.1 months for the children without ear plugs. Forty-two children (47%) who wore ear plugs developed at least one episode of otorrhea, as compared with 46 (56%) who did not use ear plugs (p = 0.21). The mean (SD) rate of otorrhea per month was 0.07 (0.31) for the children who wore ear plugs as compared with 0.10 (0.31) for the children who did not wear ear plugs (p = 0.05).
Clinical comment: Because the clinical impact of using ear plugs is small, their routine use may be unnecessary.
A systematic review 2 including 11 studies found no difference in risk of acute otitis media (AOM) in children who swam without ear protection compared with those who did not swim (OR 0.78, 95% CI 0.42 to 1.44), or compared with those who used earplugs and swimming caps (OR 0.75, 95% CI 0.38 to 1.48). There was no difference in AOM in children who used ear drops after swimming compared with those who used earplugs or swimming caps (OR 0.76, 95% CI 0.56 to 1.02). The risk of AOM was higher among children with ventilation tubes who used ear drops after swimming compared to those who did not swim (OR 3.14, 95% CI 1.40 to 7.05).
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