{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T18:31:58Z","timestamp":1786386718817,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the association between specific types of water exposure and the incidence of tympanostomy tube otorrhea (TTO) in pediatric patients following tympanostomy tube placement (TTP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Designs<\/jats:title>\n                    <jats:p>Cross\u2010sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary pediatric otolaryngology practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Caregivers of children who had undergone TTP at least 6 months prior were surveyed regarding their child's water exposure habits and episodes of otorrhea since surgery. Survey data were corroborated with medical chart review. Multivariable logistic regression was used to evaluate associations between exposure to \u201cdirty\u201d water (ocean, lake, or untreated pool water) versus \u201cclean\u201d water (chlorinated or salt\u2010treated pool water) and the risk of recurrent TTO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Caregivers of 137 eligible patients completed the survey, and 68 (49.6%) reported recurrent TTO. Adjusting for age, smoke exposure, and other potential confounders, patients exposed to dirty water had 3.18 times higher odds of developing recurrent TTO compared to patients not exposed to dirty water (95% confidence interval [CI] 1.33\u20107.62,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.009), while no significant association was observed between clean water exposure and TTO. Similar findings were observed when comparing patients with 0 versus \u22651 episode of TTO and &lt;2 versus \u22652 episodes of TTO.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exposure to untreated or natural water sources may be associated with an increased likelihood of recurrent otorrhea following TTP, while swimming in treated pools appears safe. These findings support individualized water precaution counseling rather than universal restrictions, and further research is warranted to clarify underlying biological mechanisms and modifiable risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70093","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T13:09:23Z","timestamp":1767186563000},"page":"422-429","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes and Characteristics of Water Exposure in Children with Tympanostomy Tubes"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4758-3146","authenticated-orcid":false,"given":"Alexandria L.","family":"Irace","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terri","family":"Giordano","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian","family":"Karpink","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mimi","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1472-2034","authenticated-orcid":false,"given":"Kavita","family":"Dedhia","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"},{"name":"Division of Pediatric Otolaryngology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000154742.33067.fb"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","unstructured":"MeyerCM.Swimming with tympanostomy tubes.Arch Otolaryngol Head Neck Surg.2000;126(12):1507\u20101508discussion 1509.","DOI":"10.1001\/archotol.126.12.1507"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2007.25"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjorl.2017.06.009"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198104000-00008"},{"issue":"980","key":"e_1_2_8_7_1","first-page":"244","article-title":"Swimming and grommets: a prospective survey","volume":"107","author":"Gilbert JG","year":"1994","journal-title":"N Z Med J"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198706000-00019"},{"issue":"5","key":"e_1_2_8_9_1","first-page":"305","article-title":"Post\u2010myringotomy care: a prospective study","volume":"13","author":"Arcand P","year":"1984","journal-title":"J Otolaryngol"},{"key":"e_1_2_8_10_1","unstructured":"KaufmannTU VeraguthD LinderTE.[Water precautions after insertion of a tympanostomy tube: necessary or obsolete?]. Schweiz Med Wochenschr. Oct 9 1999;129(40):1450\u20105. Wasserschutz nach Paukenrohrcheneinlage: notwendig oder obsolet?"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1996.01890150054010"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0196-0709(94)90004-3"},{"issue":"1","key":"e_1_2_8_13_1","first-page":"30","article-title":"Swimming and grommets","volume":"38","author":"Cohen HA","year":"1994","journal-title":"J Fam Pract"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100122601"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/146642409011000603"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199904000-00003"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000493"},{"issue":"1","key":"e_1_2_8_18_1","first-page":"010375","article-title":"Water precautions for prevention of infection in children with ventilation tubes (grommets)","volume":"2016","author":"Moualed D","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23993"},{"issue":"3","key":"e_1_2_8_20_1","first-page":"202410521","article-title":"Middle ear ventilation tubes and water precautions: a survey of otolaryngologists and pediatricians on their recommendations","volume":"123","author":"Herranz F","year":"2025","journal-title":"Arch Argent Pediatr"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813490141"},{"issue":"1","key":"e_1_2_8_22_1","first-page":"1","article-title":"Clinical practice guideline: tympanostomy tubes in children (update)","volume":"166","author":"Rosenfeld RM","year":"2022","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-017-4700-y"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.124.10.1118"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.70093","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ohn.70093","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.70093","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T18:27:03Z","timestamp":1786386423000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.70093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,31]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/ohn.70093"],"URL":"https:\/\/doi.org\/10.1002\/ohn.70093","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,31]]},"assertion":[{"value":"2025-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}