A comparison of different treatment modalities used as otorrhea prophylaxis following ventilation tube placement

Yıl 2020, Cilt: 30 Sayı: 3, 99 - 107, 20.09.2020

Mehmet Tekin Mustafa Avcu Harun Soyalıç Arzu Tüzüner

Öz

Objectives: This study aims to compare the efficacy and complications of different medical treatment modalities used to prevent otorrhea following ventilation tube placement. Patients and Methods: This single-center, evaluator-blinded, controlled study included a total of 241 consecutive children 137 males, 104 females; mean age: 7.3±2.6 years; range, 3 to 13 years who underwent bilateral ventilation tube placement due to bilateral serous otitis media between July 2014 and June 2016. The patients were classified according to the medical treatment protocols applied. Group 1 n=56 received oral antibiotics; Group 2 n=57 received oral antibiotics + local antibiotic ear drops; Group 3 n=65 received local antibiotic ear drops; and Group 4 n=63 received local antibiotic-glucocorticoid ear drops. Results: The lowest rate of otorrhea seen was 5.2% in Group 2, followed by 6.34% in Group 4. The highest rate of otorrhea was seen in Group 1. In the evaluation of the efficacy of the treatments, otorrhea was eliminated in Group 2 at a rate of 75% on Day 4. The same success rate was reached on Day 6 in Group 4 and on Day 12 in the other groups. The highest rate 28% of side effects was seen in Group 2. Although the rates in the groups applied with local treatments were lower than those of the other groups, the difference was not statistically significant p=0.051 . Conclusion: The administration of local antibiotic-glucocorticoid ear drops can be considered an effective and safe treatment option with similar otorrhea and lower complication rates.

Anahtar Kelimeler

Antibiotic ear drops, oral antibiotic, serous otitis media, steroid ear drops, ventilation tube placement.

Kaynakça

• Giles W, Dohar J, Iverson K, Cockrum P, Hill F, Hill N. Ciprofloxacin/dexamethasone drops decrease the incidence of physician and patient outcomes of otorrhea after tube placement. Int J Pediatr Otorhinolaryngol 2007;71:747-56.
• Steele DW, Adam GP, Di M, Halladay CW, Balk EM, Trikalinos TA. Prevention and treatment of tympanostomy tube otorrhea: A meta-analysis. Pediatrics 2017;139:e20170667.
• Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013;149(1 Suppl):S1-35.
• Badalyan V, Schwartz RH, Scwhartz SL, Roland PS. Draining ears and tympanostomy tubes: a survey of pediatric otolaryngologists and pediatric emergency medicine physicians. Pediatr Emerg Care 2013;29:203-8.
• Alvi SA, Jones JW, Porter P, Perryman M, Nelson K, Francis CL, et al. Steroid versus antibiotic drops in the prevention of postoperative myringotomy tube complications. Ann Otol Rhinol Laryngol 2018;127:445-9.
• Venekamp RP, Mick P, Schilder AG, Nunez DA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2018;5:CD012017.
• Noonan KY, Kim SY, Wong LY, Martin IW, Schwartzman JD, Saunders JE. Treatment of Ciprofloxacin-resistant Ear Infections. Otol Neurotol 2018;39:e837-e842.
• Samarei R. Comparison of local and systemic ciprofloxacin ototoxicity in the treatment of chronic media otitis. Glob J Health Sci 2014;6:144-9.
• Vaile L, Williamson T, Waddell A, Taylor GJ. WITHDRAWN: Interventions for ear discharge associated with grommets (ventilation tubes). Cochrane Database Syst Rev 2016;11:CD001933.
• Roland PS, Stewart MG, Hannley M, Friedman R, Manolidis S, Matz G, et al. Consensus panel on role of potentially ototoxic antibiotics for topical middle ear use: Introduction, methodology, and recommendations. Otolaryngol Head Neck Surg 2004;130(3 Suppl):S51-6.
• Wall GM, Singh O, Lemke L, Roland P. Review of inactive ingredients in antibiotic ear drops. Ear Nose Throat J 2009;88:E21-9.
• Daniel SJ, Munguia R. Ototoxicity of topical ciprofloxacin/dexamethasone otic suspension in a chinchilla animal model. Otolaryngol Head Neck Surg 2008;139:840-5.
• Bassim MK, Drake AF. Tympanostomy tube obstruction related to ototopical drug therapy. Ear Nose Throat J 2005;84:416-7.
• Kocaturk S, Yardimci S, Yildirim A, Incesulu A. Preventive therapy for postoperative purulent otorrhea after ventilation tube insertion. Am J Otolaryngol 2005;26:123-7.
• Chee J, Pang KW, Yong JM, Ho RC, Ngo R. Topical versus oral antibiotics, with or without corticosteroids, in the treatment of tympanostomy tube otorrhea. Int J Pediatr Otorhinolaryngol 2016;86:183-8.
• Heslop A, Lildholdt T, Gammelgaard N, Ovesen T. Topical ciprofloxacin is superior to topical saline and systemic antibiotics in the treatment of tympanostomy tube otorrhea in children: the results of a randomized clinical trial. Laryngoscope 2010;120:2516-20.
• van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder AG. A trial of treatment for acute otorrhea in children with tympanostomy tubes. N Engl J Med 2014;370:723-33.
• Brennan-Jones CG, Head K, Chong LY, Burton MJ, Schilder AG, Bhutta MF. Topical antibiotics for chronic suppurative otitis media. Cochrane Database Syst Rev 2020;1:CD013051.
• Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for treating sepsis. Cochrane Database Syst Rev 2015;2015:CD002243.
• Jassar P, Jose J, Homer JJ. Otic drops used to clear a blocked grommet: an in vitro prospective randomized controlled study with blinded assessment. Clin Otolaryngol Allied Sci 2004;29:602-5.
• . Jassar P, Jose J, Homer JJ. Otic drops used to clear a blocked grommet: an in vitro prospective randomized controlled study with blinded assessment. Clin Otolaryngol Allied Sci 2004;29:602-5.