Wang Mao-Che, Liu Chia-Yu, Shiao An-Suey
Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2009 Feb;72(2):72-5. doi: 10.1016/S1726-4901(09)70026-7.
Ventilation tube insertion is a common treatment for children with persistent otitis media with effusion. Parents are concerned about the morbidity of this procedure and the influence of ventilation tubes on daily activities. Permissibility of swimming is a question that is most often asked. The aim of this study was to investigate the possibility of water penetration through ventilation tubes into the middle ear while swimming in children with ventilation tubes under immediate observation.
We included 14 patients who had otitis media with effusion who received ventilation tube insertion. They had complete ear, nose and throat physical examination. All 14 patients were taken to enjoy surface swimming for 1 hour without ear protection. Before and after swimming, we checked the tympanic membrane and external ear canal using a videotelescope and monitor immediately at the poolside to discover if there was fluid in the external ear canal and middle ear. Patients were followed-up 2 weeks later to check if otorrhea had occurred.
The 14 patients were from 5 to 14 years old. Nine were male and 5 were female. Nine patients had bilateral ventilation tubes and 5 had unilateral ones. One ear was excluded due to the tube nearly dropping out. A total of 22 ears were included. Eight ears were noted to be dry after swimming. Five ears were noted to have water over the outer 1 third of the external ear canal. Two ears were noted to have water over the inner 2 thirds of the external ear canal. Water on the tube or tympanic membrane was found in 6 ears. Only 1 ear with water penetration into the middle ear was found. No otorrhea had occurred in any ears after 2 weeks.
Water penetration into the middle ear through ventilation tubes and middle ear infection are not likely when surface swimming. Children with ventilation tubes can enjoy swimming without protection in clean chlorinated swimming pools.
置管通气是治疗儿童持续性中耳积液的常用方法。家长们担心该手术的发病率以及通气管对日常活动的影响。能否游泳是最常被问到的问题。本研究的目的是在直接观察下，调查置有通气管的儿童游泳时水通过通气管进入中耳的可能性。
我们纳入了14例接受置管通气治疗的中耳积液患儿。他们均接受了完整的耳鼻喉科体格检查。所有14例患儿均在未采取耳部保护措施的情况下进行了1小时的水面游泳。游泳前后，我们使用电子视频耳镜在泳池边立即检查鼓膜和外耳道，以发现外耳道和中耳是否有积液。2周后对患儿进行随访，检查是否发生耳漏。
14例患儿年龄在5至14岁之间。9例为男性，5例为女性。9例患儿双耳置管，5例患儿单耳置管。有1只耳朵因通气管几乎脱落而被排除。共纳入22只耳朵。游泳后发现8只耳朵干燥。5只耳朵外耳道外1/3有积水。2只耳朵外耳道内2/3有积水。6只耳朵的通气管或鼓膜上有水。仅发现1只耳朵有水进入中耳。2周后所有耳朵均未发生耳漏。
水面游泳时，水不太可能通过通气管进入中耳并引发中耳感染。置有通气管的儿童可以在干净的含氯游泳池中无需保护地游泳。
