A helpful technique for water precautions following ear
surgery: Utilising the anaesthetic air cushion mask
Gloucester Royal Hospital, Gloucester, UK
M.S. Osborne, Gloucester Royal Hospital, Gloucester, UK.
No Funding or sponsorship to declare.
Water avoidance in the immediate postoperative period following
ear surgery is vital to prevent infection, allow incisions to heal and
so lead to an improvement in recovery rates. Advice regarding this is
varied from 24 hours-several weeks depending on the surgical
approach and surgeon preference.
Advice is usually given to prevent water from entering the ear
canal by barrier methods such as cotton wool covered in petroleum
jelly, custom ear plugs, putty or bathing caps. Water contact with
incisions should be avoided until healed. Cotton wool with petro-
leum jelly has been demonstrated the easiest to use and insert into
the ear canal and is the most effective barrier method
it is also bet-
ter at preventing leaks as compared to customised earplugs.
especially important if the patient is using surfactant products while
showering as the resulting reduction in water tension allows for
easier penetration of water into the canal.
In surgery which aims to reconstruct an intact tympanic membrane
such as myringoplasty, water precaution advice should be continued
until complete healing has occurred. In tympanostomy tube insertion,
advice regarding water precaution is varied with no single consensus;
however, a survey conducted in 2007 reported that 69.1% of otolaryn-
gologist would advise the use of ear plugs following tympanostomy
tube insertion while bathing. The same study also demonstrated that
74% of otolaryngologists would advocate the use of ear plugs while
bathing following myringoplasty, 65.4% following mastoidectomy.
The authors have developed a novel use for the anaesthetic air
cushion mask to improve postoperative water precautions. The
masks which are used at induction are disposed of after a single use.
Utilisation of the mask can be greatly improved by reusing it to
provide excellent water barrier upon discharge from hospital. The
technique described in this article is intuitive and simple to adopt
and would take no additional time for clinical staff to demonstrate.
The mask should be used in conjunction with standard barrier
method advice given at the time of discharge.
While the patient is bathing/showering, the mask should be placed
over the postoperative ear (see Figure 1 & 2) with gentle pressure. The
soft cushion of the mask conforms to the shape of the temporal region
creating a gentle, comfortable, soft, low-pressure seal around the ear
and acts as an additional barrier. The authors consider that this will
help in reducing the incidence of infection rates by both reducing the
entrance of water into the external ear canal and by keeping post-auri-
cular and endaural surgical incisions dry. This technique may also be of
benefit to children who are non-compliant to other ear canal barrier
techniques due to discomfort. Prior to its use, the open connection
port of the mask can be simply sealed with Sellotape to prevent water
entrance. This can be replaced when required by the patient.
Surgical site infection can cause significant morbidity to patient which
not only results in increased cost of care but also cost to patient in
terms of reduced productivity and time lost. Overall infection rates fol-
lowing ear surgery occur at levels between 6% and 10%.
dence of a single episode of otorrhoea post-tympanotomy tube
insertion is also high reported between 5 and 49%
in the acute phase
(within 4 weeks following of the procedure) and can occur between
26% and 83% within 18 months
although overall incidence of chronic
otorrhoea is much lower, 3.8%
The air cushion mask is used by anaesthetist during induction to
pre-oxygenate and to give volatile anaesthetics prior to securing the
airway. Once used, this mask is disposed of; therefore, provision of
the same mask to the patient would incur no additional cost.
Accepted: 12 March 2017
Clinical Otolaryngology. 2018;43:777–778. wileyonlinelibrary.com/journal/coa © 2017 John Wiley & Sons Ltd