What is the best way to treat tympanostomy tube otorrhea?

Antibiotic-glucocorticoid eardrops are more effective than oral antibiotics in controlling otorrhea in children with tympanostomy tubes, a recent trial showed.

Investigators assigned 230 children aged from 1 to 10 years (median age, 4.5 years) with acute tympanostomy-tube otorrhea to receive hydrocortisone-bacitracin-colistin eardrops or oral amoxicillin-clavulanate suspension, or to undergo initial observation. Two weeks later, the children were assessed otoscopically for otorrhea and were followed for 6 months to compare the treatments for several outcomes.

The eardrops were superior to oral antibiotics and initial observation in every way. After 2 weeks, 5% of children treated with the eardrops (5 drops 3 times daily for 7 days) had otorrhea compared with 44% of those treated with oral antibiotics (30 mg of amoxicillin and 7.5 mg of clavulanate per kilogram of body weight per day, divided into 3 daily doses) and 55% of those who underwent observation only. Furthermore, the initial episode of otorrhea was 4 days for children given the eardrops, 5 days for oral antibiotics, and 12 days for those assigned to observation.

A comparison of results of questionnaires administered to parents at baseline and again at 2 weeks of follow-up found that generic quality-of-life scores did not differ significantly among the study groups.

During 6 months of follow-up, the median total number of days with otorrhea was 5 for children receiving eardrops; 13.5 for youngsters receiving oral antibiotics; and 18 for those assigned to initial observation. As for median number of recurrent episodes of otorrhea during 6 months of follow-up, the numbers for these groups were 0, 1, and 1, respectively.

Treatment-related adverse events were mild and, at 2 weeks, parents had not reported any complications of otitis media (van Dongen TM, et al. N Engl J Med. 2014;370[8]:723-733).

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. He is a contributing editor for Contemporary Pediatrics. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.