Eardrops are the answer for tube-related otorrhea

Topical antibiotic-glucocorticoid eardrops are superior to oral antibiotics and observation for acute uncomplicated otorrhea in children with tympanostomy tubes.

The finding comes from an open-label, randomized, controlled trial conducted in the Netherlands. Researchers studied 230 children aged between 1 and 10 years. Approximately one-third of the group received hydrocortisone-bacitracin-colistin eardrops; another third received oral amoxicillin-clavulanate suspension; and the remainder was simply observed.

After 2 weeks of treatment, only 5% of the children who received the eardrops still had otorrhea, versus almost half (44%) of those who received oral treatment and more than half (55%) of those who received observation.

The eardrops also worked the fastest. The initial episode of otorrhea lasted on average 4 days in the children who received the eardrops, 5 days in the oral suspension group, and 12 days in those who were only observed.

The findings are in keeping with the clinical practice guidelines regarding tympanostomy tubes in children issued by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), which state that antibiotic eardrops, and not oral antibiotics, are the appropriate treatment for acute tympanostomy tube otorrhea.

The investigators note that the eardrops they used are not routinely available outside the Netherlands and France, although they are the most commercially available ones inside the Netherlands. They believe that any eardrop containing an antibiotic with similar antimicrobial activity, such as ciprofloxacin, combined with a glucocorticoid, such as dexamethasone, would produce similar results. The AAO-HNS guidelines mention ofloxacin or ciprofloxacin-dexamethasone.

According to the guidelines, nearly 670,000 children in the United States receive tympanostomy tubes annually. About 16% of these children develop otorrhea within 4 weeks of the procedure and one-quarter suffers from otorrhea at any time the tubes are in place. 

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