Impact of swimming on chronic suppurative otitis media in Aboriginal children: a randomised controlled trial

Anna T N Stephen, Amanda J Leach and Peter S Morris
Med J Aust 2013; 199 (1): 51-55. || doi: 10.5694/mja13.10533


Objectives: To measure the impact of 4 weeks of daily swimming on rates of ear discharge among Aboriginal children with a tympanic membrane perforation (TMP) and on the microbiology of the nasopharynx and middle ear.

Design, setting and participants: A randomised controlled trial involving 89 Aboriginal children (aged 5–12 years) with a TMP, conducted in two remote Northern Territory Aboriginal communities from August to December 2009.

Intervention: 4 school weeks of daily swimming lessons (45 minutes) in a chlorinated pool.

Main outcome measures: Proportions of children with ear discharge and respiratory and opportunistic bacteria in the nasopharynx and middle ear.

Results: Of 89 children randomly assigned to the swimming or non-swimming groups, 58 (26/41 swimmers and 32/48 non-swimmers) had ear discharge at baseline. After 4 weeks, 24 of 41 swimmers had ear discharge compared with 32 of 48 non-swimmers (risk difference, 8% (95% CI, 28% to 12%). There were no statistically significant changes in the microbiology of the nasopharynx or middle ear in swimmers or non-swimmers. Streptococcus pneumoniae and non-typeable Haemophilus influenzae were the dominant organisms cultured from the nasopharynx, and H. influenzae, Staphylococcus aureus and Pseudomonas aeruginosa were the dominant organisms in the middle ear.

Conclusions: Swimming lessons for Aboriginal children in remote communities should be supported, but it is unlikely that they will substantially reduce rates of chronic suppurative otitis media and associated bacteria in the nasopharynx and middle ear. However, swimming was not associated with increased risk of ear discharge and we found no reason to discourage it.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000634774.

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  • Anna T N Stephen1
  • Amanda J Leach2
  • Peter S Morris3

  • Child Health Division, Menzies School of Health Research, Royal Darwin Hospital, Darwin, NT.


The Sidney Myer Fund and National Health and Medical Research Council provided funding for our study. We thank families and children who participated in the study, the NT Department of Health and Families, the community health boards, NT Catholic Education, staff at Murrupurtiyanuwu Catholic Primary School (Nguiu) and Our Lady of the Sacred Heart Thamarrurr Catholic College (Wadeye), pool staff at Wadeye and Nguiu, and Swimming NT. We also thank the following collaborators for their contributions to the field and laboratory data collection and analysis: Joseph McDonnell (statistical analysis), Christine Cooper, Christine Wigger (ear examiners), Kim Hare and Vanya Hampton (laboratory scientists) and Jemima Beissbarth (data management).

Competing interests:

Amanda Leach receives funding from Wyeth/Pfizer and GlaxoSmithKline Australia. Peter Morris receives funding from GlaxoSmithKline Australia.

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