Hebert R L, King G E, Bent J P
Division of Otolaryngology, Medical College of Georgia, Augusta, USA.
Arch Otolaryngol Head Neck Surg. 1998 Oct;124(10):1118-21. doi: 10.1001/archotol.124.10.1118.
To determine whether water exposure causes middle ear contamination in patients with collar button tympanostomy tubes (TTs).
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.
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.
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).
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.
确定水接触是否会导致带纽扣式鼓膜造孔管（TTs）的患者中耳污染。
构建了一个包含耳廓、外耳道、带TTs的鼓膜、中耳、咽鼓管和乳突腔的人体头部体外模型。连接到外部欧姆表的两个电极置于中耳以检测水的进入。该模型接受了4种水接触方式的测试：淋浴、盆浴、冲洗头发和游泳。采用Fisher精确检验进行统计分析。
阳性测试结果对应水通过TTs进入中耳，通过欧姆表电阻读数为零来确认。阴性测试结果表明初始高电阻读数无变化。
淋浴（60次测试中0次）、冲洗头发（60次测试中0次）或在清洁自来水中头部浸没（12.7厘米）（60次测试中0次）均未获得阳性测试结果。在肥皂水中头部浸没获得了10次阳性测试结果（97次测试中10次），与清洁水相比有统计学差异（P≤0.007）。游泳池深度为30、45、60和75厘米时，分别在16次测试中的2次、18次测试中的3次、20次测试中的2次和20次测试中的11次获得阳性测试结果。中耳进水发生率在深度超过60厘米时更高（P≤0.001）。60厘米及以下深度之间无统计学差异（P = 0.88）。
淋浴、冲洗头发和在清洁自来水中头部浸没不会促使水进入中耳。浸没在肥皂水中会增加水污染的可能性。头部浸没时泳池水很少进入中耳，但随着游泳深度增加（>60厘米）发生率会升高。这些数据进一步证明，经常建议TTs患者采取的许多防水措施是不必要的。
