{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:20:27Z","timestamp":1777594827679,"version":"3.51.4"},"reference-count":41,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,6,1]]},"abstract":"\n CONTEXT:<\/jats:title>\n Children with tympanostomy tubes often develop ear discharge.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE:<\/jats:title>\n Synthesize evidence about the need for water precautions (ear plugs or swimming avoidance) and effectiveness of topical versus oral antibiotic treatment of otorrhea in children with tympanostomy tubes.<\/jats:p>\n <\/jats:sec>\n \n DATA SOURCES:<\/jats:title>\n Searches in Medline, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature.<\/jats:p>\n <\/jats:sec>\n \n STUDY SELECTION:<\/jats:title>\n Abstracts and full-text articles independently screened by 2 investigators.<\/jats:p>\n <\/jats:sec>\n \n DATA EXTRACTION:<\/jats:title>\n 25 articles were included.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n One randomized controlled trial (RCT) in children assigned to use ear plugs versus no precautions reported an odds ratio (OR) of 0.68 (95% confidence interval, 0.37\u20131.25) for &gt;1 episode of otorrhea. Another RCT reported an OR of 0.71 (95% confidence interval, 0.29\u20131.76) for nonswimmers versus swimmers. Network meta-analyses suggest that, relative to oral antibiotics, topical antibiotic\u2013glucocorticoid drops were more effective: OR 5.3 (95% credible interval, 1.2\u201327). The OR for antibiotic-only drops was 3.3 (95% credible interval, 0.74\u201316). Overall, the topical antibiotic\u2013glucocorticoid and antibiotic-only preparations have the highest probabilities, 0.77 and 0.22 respectively, of being the most effective therapies.<\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS:<\/jats:title>\n Sparse randomized evidence (2 RCTs) and high risk of bias for nonrandomized comparative studies evaluating water precautions. Otorrhea treatments include non\u2013US Food and Drug Administration approved, off-label, and potentially ototoxic antibiotics.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n No compelling evidence of a need for water precautions exists. Cure rates are higher for topical drops than oral antibiotics.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2017-0667","type":"journal-article","created":{"date-parts":[[2017,5,5]],"date-time":"2017-05-05T09:10:13Z","timestamp":1493975413000},"source":"Crossref","is-referenced-by-count":16,"title":["Prevention and Treatment of Tympanostomy Tube Otorrhea: A Meta-analysis"],"prefix":"10.1542","volume":"139","author":[{"given":"Dale W.","family":"Steele","sequence":"first","affiliation":[{"name":"Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and"},{"name":"Departments of Health Services, Policy and Practice, School of Public Health,"},{"name":"Emergency Medicine, Section of Pediatrics\u2013Hasbro Children\u2019s Hospital, and"},{"name":"Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaelen P.","family":"Adam","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengyang","family":"Di","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher W.","family":"Halladay","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan M.","family":"Balk","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and"},{"name":"Departments of Health Services, Policy and Practice, School of Public Health,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas A.","family":"Trikalinos","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and"},{"name":"Departments of Health Services, Policy and Practice, School of Public Health,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2017,6,1]]},"reference":[{"issue":"7","key":"2021121015123052900_B1","doi-asserted-by":"crossref","first-page":"e69062","DOI":"10.1371\/journal.pone.0069062","article-title":"Parent-reported otorrhea in children with tympanostomy tubes: incidence and predictors.","volume":"8","author":"van Dongen","year":"2013","journal-title":"PLoS One"},{"issue":"8","key":"2021121015123052900_B2","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1002\/lary.25826","article-title":"Identification of biofilms in post-tympanostomy tube otorrhea.","volume":"126","author":"Idicula","year":"2016","journal-title":"Laryngoscope"},{"issue":"2","key":"2021121015123052900_B3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1001\/archoto.2007.25","article-title":"Pacific Northwest survey: posttympanostomy tube water precautions.","volume":"134","author":"Poss","year":"2008","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"1","key":"2021121015123052900_B4","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1177\/0194599813490141","article-title":"Clinical practice guideline: tympanostomy tubes in children.","volume":"149","author":"Rosenfeld","year":"2013","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"4","key":"2021121015123052900_B5","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/coa.12530","article-title":"Water precautions following ventilation tube insertion: what information are patients given? 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