Topical Ear Drops Research Articles

Comparision of effectiveness of topical acetic acid instillation with topical antibiotics in madical management of tubotympanic chronic suppurative otitis media (CSOM)

Chronic Suppurative Otitis Media (CSOM) is typically a persistent disease, insidious in onset, often capable of causing irreversible sequel and severe destruction that clinically manifests with discharge and deafness. CSOM is a major health problem in developing countries causing serious local damage and life-threatening complications. In developing countries, it accounts for 60-80% of middle ear diseases. Its incidence to some extent depends on racial and socioeconomic factors. The study was carried out in ENT Department, Sir T Hospital, Bhavnagar. A total of 200 patients having complain of ear discharge were randomly distributed in two groups. In one group (group A) patients were treated with topical acetic acid ear drops and in other (group B) patients were treated with topical antibiotics ear drops. Among 200 patient’s majority of the cases were in age group of 18 to 30 yrs. Male patients are predominantly affected than other patients.The study was prospective and observational based on symptomatic relief of problems caused by the pathogens in CSOM by removing or killing the related pathogens and making the ear dry.

Analyzing the Efficacy of Topical Ciprofloxacin Ear Drops vs. Oral Tablets and Topical Ciprofloxacin Ear Drops Together for the Treatment of Patients with Chronic Suppurative Otitis Media (CSOM-Tubotympanic Type)

Background: A suppurative Middle ear infection is the most frequent kind of otitis externa in low-income regions of the world (CSOM). Suppurative otitis media (CSOM-tubo tympanic type) affects both young and old alike. The condition has been treated using a wide range of approaches. Objectives: The purpose of this study was to evaluate the efficacy of oral and topical ciprofloxacin against topical ciprofloxacin drops alone in the treatment of CSOM-tubo tympanic ear discharge. Methods: Randomization was used in our study Patients with chronic suppurative otitis media were seen between September 2020 and September 2021 at tertiary care hospital in Peshawar. SPSS version 24 was used to evaluate hospital and pathology lab data. Results: Overall, 75 patients were included in the study's findings. They split themselves into two categories. There were 38 people [group A] and 37 people [ group B]. each Group was classified into two age groups, the younger [ages 01–12] and the older (ages 13–60). (age 13-16 years). Patients' ages ranged from 1 to 12 years old, with 28 [group-A] at 72% and 25 [group-B] at 65%. Ten people 27% in [group-A] and thirteen patients (35%) in [group B], were between the ages of thirteen and sixteen (group B). Conclusions: As a result, we found that the combination of oral and topical ciprofloxacin was superior to topical ciprofloxacin alone in resolving ear discharge in patients with middle ear CSOM (tubo-tympanic type). Keywords: Topical and oral ciprofloxacin, treat chronic suppurative, otitis media

Ototoxicity of Topical Antibiotic Ear Drops in Chronic Suppurative Otitis Media in Humans: A Review of the Literature.

An electronic search of the literature was performed for reported cases of ototoxicity associated with the use of topical antibiotic ear drops in humans. The dosage, duration, and type of ototoxic preparations involved were recorded. Due to the scant quantity of low-quality information that is currently available, there was uncertainty about the usefulness of topical antibiotics in enhancing the resolution of ear discharge in patients with chronic suppurative otitis media. However, despite this uncertainty, there are some data to show that using topical antibiotics in comparison to a placebo or in conjunction with a systemic antibiotic may be useful. Additionally, there is ambiguity regarding the relative efficacy of various kinds of antibiotics; it is impossible to say with absolute certainty whether quinolones are superior to or inferior to aminoglycosides. Although the adverse impact profiles of these two classes of chemicals varied, there are not enough data from the included trials to draw any conclusions about them. Negative effects were generally underreported.

A Comparative Study between Topical Versus Combined (Systemic Plus Topical) Therapy in Ciprofloxacin-Sensitive Chronic Suppurative Otitis Media (Tubotympanic)

Introduction: Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharge or otorrhea through a tympanic perforation. Aim: The study aimed to compare the effectiveness of topical versus combined (systemic and topical) therapy in ciprofloxacin-sensitive CSOM (tubotympanic). Materials and Methods: A hospital-based prospective study of 100 patients aged >18 years with clinically diagnosed CSOM (tubotympanic type) was conducted. After aural toilet, patients were randomly assigned to one of the two treatment groups: Group A (topical ciprofloxacin ear drops) Group B (topical plus oral ciprofloxacin). These patients were received 1 week of treatment and followed up on day 3 and day 7. Statistical comparisons were performed using Chi-square test. Results: In this study, maximum numbers of patients were found in the age group of 20–29 years. Patients in Group A (topical ciprofloxacin ear drops) showed less side effects in comparison to Group B (topical plus oral ciprofloxacin). Forty-one (82%) patients showed improvement in Group A, whereas 43 (86%) patients in Group B. Conclusion: Topical ciprofloxacin drops were as effective as combined (oral plus topical ciprofloxacin) and that the addition of oral drug did not have any beneficial effect adding only to the side effects and to the cost of treatment.

Comparing Oral Moxifloxacin and Ciprofloxacin Ear Drops Versus Ciprofloxacin Ear Drops Only in Patients with Active Mucosal Chronic Otitis Media

Objective: To compare the effects of Oral Moxifloxacin and topical antibiotic ear drops in patients with active mucosal chronic otitis media.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Combined Military Hospital Bahawalpur, from May 2018 to Apr 2020.
 Methodology: A total of 100 patients with Active (mucosal) Chronic Otitis Media were included in the study. These patients were divided into two groups. The first group received oral Moxifloxacin and topical Ciprofloxacin ear drops, while the second group only received topical ciprofloxacin ear drops. Clinical success was compared in both groups regarding patients becoming asymptomatic and having a dry ear on examination.
 Results: 45(90%) patients in combined treatment while 35 (70%) in the topical ciprofloxacin ear drops group became asymptomatic. The Chi-square test was applied (6.25). The p-value was .124. We found that oral Moxifloxacin, in addition to topical Ciprofloxacin ear drops, is a superior treatment option in decreasing the symptoms of tubotympanic chronic otitis media (COM) than the topical ciprofloxacin ear drops when used alone.
 Conclusion: Moxifloxacin is an effective drug in controlling symptoms of tubotympanic chronic supportive otitis media, and its combination with topical ciprofloxacin ear drops is superior to the ciprofloxacin ear drops when used alone.

A contemporary overview on the enigma of managing recalcitrant or intractable post-operative otorrhoea following middle-ear surgery: perspectives, principles and practices.

A common problem in otological surgeries is the persistence of ear discharge in a patient who has undergone middle-ear reconstructive surgery, despite an intact graft. There is a dearth of knowledge in the literature on treatment strategies in such post-operative cases of recalcitrant otorrhoea. This was a retrospective observational descriptive study conducted on 45 patients who fitted the criteria for recalcitrant post-operative otorrhoea. All 45 patients showed no response to conservative treatment for 14 days from onset of discharge. Therefore, these patients were then given antiseptic ear drops. Thirty patients out of 45 showed a good response to antiseptic ear drops and achieved a dry ear at the end of the treatment. In patients with recalcitrant otorrhoea with or without granulations after middle-ear reconstruction surgery, this study found that topical antiseptic ear drops, particularly those using boric acid powder, are more effective than topical antibiotic drops.

Comparison of Efficacy of Topical Ciprofloxacin Ear drops (0.6%) Versus a Combination of Systemic with Topical Ciprofloxacin in Treating Chronically Discharging Ears

Objective: To compare the efficacy of topical ciprofloxacin alone, versus a combination therapy ofsystemic with topical ciprofloxacin(0.6%) in achieving dry ears in active mucosal chronic otitis media after two weeks of treatment. Methods: After obtaining permission from ethical committee of Hospital, an over-all of 150 patients (with 75 subjects each, divided into two groups) were included in this study. In Group-A: Topical Ciprofloxacin ear drops (0.6%) 3-4 drops were instilled three times a day, 8 hours apart for 2 weeks. In Group-B: Tab Ciprofloxacin 500mg was given twice a day, 12 hours apart for 14 days along with topical Ciprofloxacin ear drops (0.6%) 3 drops were used thrice a day, 8 hours apart for 14 days. Results: Patients ranged between 15-45 years of age. Mean age of the patients was 30.3±7.4 and 29.2±7.7 years. In group-A, there were 41 males (54.7%) and in group-B 49 males (65.3%). Females were 34 (45.3%) in group-A and 27 (36%) in Group-B. Mean duration of ear discharge was 5.3±1.1 months in group-A while 5.5±1.4 months in Group-B. We could not find any substantial variation among the two group in terms of efficacy (p=0.249). Stratification with regard to age, gender and duration of ear discharge was also carried out. Conclusion: Results of this study showed that topical ciprofloxacin ear drops (0.6%) were equally effective as systemic ciprofloxacin combined with topical ciprofloxacin (0.6%), for treating chronically discharging ears. Keywords: CSOM, ciprofloxacin, nature of discharge

Microbiological profile and their antibiotic sensitivity pattern in patients of chronic suppurative otitis media at eastern tertiary care center of Nepal

Chronic suppurative otitis media (CSOM) is one of the most common and an important global public health problem leading to hearing impairment and is particularly prevalent in developing countries. Even in this era of powerful antibiotics, due to increased irrational use of wide spectrum antibiotics, the resistance in the bacterial isolates is common. The objective of the study was to determine the aerobic bacterial etiology of patients with CSOM and the antimicrobial susceptibility of the bacteria isolated.A descriptive cross sectional study was carried out in 112 patients suffering from chronic discharging ear. Pus samples were cultured aerobically. Antibiotic sensitivity testing was performed with standard antibiotic discs using modified Kirby-Bauer disk diffusion method.Out of 112 patients, 70 (62.5%) were females. Among 112 swab cultures, 98 (87.5%) were positive for the growth of organism and 14 (12.5%) were sterile cultures. Among them Staphylococcus aureus (42.24%), Pseudomonas aeruginosa (28.44%), Klebsiella pneumoniae (10.34%), Acinetobacter anitratus (6.9%), Proteus mirabilis (5.17%) and E. coli (4.31%) were the common microbial isolates. Among the antibiotics commonly available as topical eardrops, Ofloxacin (91.83%)) had the highest susceptibility rate, followed by Ciprofloxacin (81.63%), Tobramycin (73.46%) and Gentamicin (63.26%).Staphylococcus aureus was the most common organism isolated followed by Pseudomonas aeruginosa. Ofloxacin had the highest susceptibility rate against the isolated organisms.

Aural toilet (ear cleaning) for chronic suppurative otitis media.

Aural toilet (ear cleaning) for chronic suppurative otitis media.

Diffuse acute otitis externa

Diffuse acute otitis externa (OEAD) is one of the most frequent cases recorded in Otorhinolaryngological emergency room. The main symptoms include: acute otalgia, feeling of ear fullness, itching, hearing impairment, sometimes fever. Otoscopy is the basic part of the diagnosis. First-line treatment involves topical antibiotic eardrops with or without a steroid. Clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane. Systemic antibiotics should not be prescribed in the first stage of the therapy unless the patient is at risk of severe course of the disease.

Surgical versus Conservative Management of Granular Myringitis: A single-centre Randomized Control Trial

Background: Treatment of granular myringitis (GM) is diverse with no definitive management.
 Objective: The aim of the present study was to see the effectiveness of different interventions for treating granular myringitis.
 Methodology: This was a single centred, parallel, randomized control trial. This study was done at the Specialized ENT Hospital of SAHIC, Dhaka from July 2010 to June 2012. Patients presenting with granular myringitis of 18 years of age or more with both sexes were included. All patients were divided into two groups by simple random sampling method of which patients of group A were treated by surgical treatment and that of group B were treated by medical treatment. Medical treatment was given in the form of topical ear drops and surgical treatment was performed by surgical debridement of granulation tissue followed by chemical cauterization. Repeated follow up was performed up to 6 months in both groups of treated patients. The primary outcome was the resolution of granulation tissue. During follow-up the secondary outcome variables were recurrence, perforation of the TM and any other complications or complain from the patients.
 Results: A total number of 60 patients were studied of which 30 patients were treated medically and 30 patients were treated surgically. The cure rate was higher in surgical treatment (80%) than conservative (16.7%) (p=0.011). The recurrence rate (17.24%) is also less in surgical group compared to medical treatment group (77.27%) (p=0.001).
 Conclusion: Surgical treatment is a more successful treatment modality for granular myringitis.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 64-68

Are topical anesthetic eardrops effective to reduce pain in children with acute otalgia?

Are topical anesthetic eardrops effective to reduce pain in children with acute otalgia?

Aerobic bacteriology of chronic suppurative otitis media in Rajahmundry, Andhra Pradesh, India

This is an aerobic bacteriological study of chronic suppurative otitis media to identify common pathogens and to evaluate their antibiotic susceptibility pattern. Hundred and fifty patients who had chronic ear discharge and had not received antibiotics recently were selected. Swabs were taken and cultured for bacteria aerobically. Antibiotic testing was done using modified Kirby–Bauer disk diffusion method. In addition to the usual antibiotics, three antibiotics commonly available as topical ear drops were tested. There were 192 bacterial isolates comprising mainly Staphylococcus aureus (36%), Proteus species (32%), Pseudomonas aeruginosa (24%), and coagulase-negative Staphylococcus (20%). Among the topical antibiotics, ciprofloxacin had the highest susceptibility rate (89%) for all the isolates tested followed by gentamicin (76.5%) and chloramphenicol (59.3%).

Bismuth Iodoform Paraffin Paste [bipp] Wick versus Topical Levofloxacin Drops in Rapid Drying of Wet Ear in Tubotympainic Chronic Suppurative Otitis Media

Background and objectives: Topical ear drops have been the mainstay in the medical management of actively dis- charging chronic suppurative otitis media with central perforation. Bismuth Iodoform Paraffin Paste has been used over the past 30 years for various clinical purposes on skin and mucosa without any serious local or systemic ad- verse effects. The aim of this study was to evaluate if Bismuth Iodoform Paraffin Paste can be used topically in the treatment of chronic superlative otitis media–tub tympanic disease and to compare it with Levofloxacin ear drops. Methods:Prospective comparative study was done in academic tertiary medical center and private clinic fromMarch 2014 to March 2016. Sixty patients with chronic suppurative otitis media tub tympanic type were ran- domized into 2 groups. One group (30 patients) received Bismuth Iodoform Paraffin Paste wick after meticu- lous aural toilet by suction clearance and dry mopping with or without using microscope accordingly, while the other group (30 patients) received topical Levofloxacin ear drops. Results: Clinical improvement at the end of fourth day study was 90% in the BIPP group and 67% in the levoxacin group, and was 97%, 93% in BIPP, Levofloxacin group respectively, at the end of 10 day. The most commonly isolated organism was Pseu- domonas aeruginosa. Conclusion: The results show that clinically, topical Bismuth Iodoform Paraffin Paste is more effective than topical levoxacin in this short time, besides; there is the benefit of low cost of therapy.

Topical ear drop self-medication practice among the Ear, Nose, and Throat patients in Ido Ekiti, Nigeria: A cross - sectional study.

Background:Self-medication is a common habit in our country; Nigeria, especially among patients with otorhinolaryngological disorders. Medication when taken wrongly may bring dire consequences to the individual, such as masking developing diseases and may cause many other undesirable effects. The aim of this study was to determine the prevalence and to analyze topical ear drop self-medication practices among respondents attending the Ear, Nose, and Throat Clinic of Federal Teaching Hospital Ido Ekiti, Nigeria.Design and Methodology:A 6-month hospital based cross-sectional study was conducted among patients who were seen in the Ear, Nose, and Throat facility of Federal Teaching Hospital, Ido Ekiti from July to December 2016 to determine topical ear drop self-medication practices. A pretested semi-structured questionnaire was used to obtained information from respondents.Results:A total of 162 respondents out of 493 patients seen during the study had otological problems. Of which 107 (66%) respondents had engaged in self-medication with topical ear drops. Their ages ranged between 2 and 83 years with a mean age of 36.6 ± 19.1 years. There were 75 males and 87 females. The major reason for self-medication was that their ailments were minor in about 40.2% and the most common indication for self-medication was ear blockage with hearing impairment (33.6%). Pharmacy/chemist shops (42%) were major sources of information for those that self-medicated. Chloramphenicol and gentamycin were the major drugs that were used by the respondents.Conclusion:Majority of the respondents in this study practiced self-medication using different topical ear drops. Major source of information on the topical ear drops used was from pharmacy/chemist shops. There is a need for adequate public health education to create awareness among people on the danger of self-medication and to enact or enforce the law to reduce access to over the counter drugs. Healthcare should be made available and avoidable at primary health-care level.

Prophylactic Tobramycin Drops After Tympanostomy Tube Placement

Tympanostomy tube insertion remains one of the most commonly performed surgeries in ENT practice. Post-operative infections remain one of the common complications after surgeries. Topical antibiotic ear drops are used to reduce the risk of this complication. The aim of this study was to assess the role of antibiotic ear drops (Tobramycin) in prevention of post-operative infection. A randomized controlled trial was done on 84 patients complaining of bilateral secretory otitis media, were operated using ventilation tube insertion. All patients were randomly allocated into two groups. The first group (group A) was the intervention group, in which all patients were given local tobramycin ear drops for five days post operatively to decrease otorrhea. The other group (group B) was the control group and no ear drops were prescribed post operatively. All patients in both groups were followed up to 14 days post operatively. A statistically significant decrease was observed in the incidence of post tympanostomy otorrhea and infections between the treatment group (group A = 7.1%), and the control group (group B = 14.2 %) (P<0.05). To conclude, antibiotic ear drops should be prescribed to all patients who are undergoing tympanostomy tube insertion. A 5-day course post operatively with tobramycin local drops is recommended.

Povidone iodine soaked gelfoam for the treatment of recalcitrant otomycosis – Our experiences at a tertiary care teaching hospital of eastern India

Otomycosis is a common clinical condition seen in outpatient department of otorhinolaryngology. The treatment of the otomycosis is also very simple. However, sometime it is difficult to treat otomycosis along with mastoid cavity, chronic suppurative otitis media, immunocompromised patient, etc. with conventional treatment, called recalcitrant otomycosis. Here, we describe a technique of treatment for recalcitrant otomycosis. This is a prospective observational study/clinical trial carried out on 44 patients of recalcitrant otomycosis. They are divided into two groups, each of 22. One group treated with routine clotrimazole topical eardrops whereas other group treated with povidone iodine soaked gelfoam, placed in the external auditory canal. There was no significance difference according to the age (P=0.134), gender (P=0.760) and causative agents (P=0.750) between treatment groups. The resolution of the symptoms showed statistically significant on itching (P=0.0001), otorrhoea (P=0.0033), fullness (P=0.0432) and earache (P=0.0259), whereas no statistical significant on hearing loss (P=0.0683), when treating with povidone iodine soaked gelfoam as compared to routine (clotrimazole) treatment. Resolution of signs like canal wall erythema (P=0.0045), tragal tenderness (P=0.0012) and congestion of tympanic membrane (P=0.0088) is statistically significant when comparing clotrimazole with povidone iodine. Apart from these, we did not reveal any adverse effects from the study populations treated with povidone iodine soaked gelfoam. Use of the povidone iodine soaked gelfoam at the external auditory canal in recalcitrant otomycosis is an effective and well-tolerated treatment.

Bismuth Iodoform Paraffin Paste [bipp] Wick versus Topical Levofloxacin Drops in Rapid Drying of Wet Ear in Tubotympainic Chronic Suppurative Otitis Media

Background and objectives: Topical ear drops have been the mainstay in the medical management of actively discharging chronic suppurative otitis media with central perforation. Bismuth Iodoform Paraffin Paste has been used over the past 30 years for various clinical purposes on skin and mucosa without any serious local or systemic adverse effects. The aim of this study was to evaluate if Bismuth Iodoform Paraffin Paste can be used topically in the treatment of chronic superlative otitis media–tub tympanic disease and to compare it with Levofloxacin ear drops.Methods:Prospective comparative study was done in academic tertiary medical center and private clinic from March 2014 to March 2016. Sixty patients with chronic suppurative otitis media tub tympanic type were randomized into 2 groups. One group (30 patients) received Bismuth Iodoform Paraffin Paste wick after meticu- lous aural toilet by suction clearance and dry mopping with or without using microscope accordingly, while the other group (30 patients) received topical Levofloxacin ear drops. Results: Clinical improvement at the end of fourth day study was 90% in the BIPP group and 67% in the levoxacin group, and was 97%, 93% in BIPP, Levofloxacin group respectively, at the end of 10 day. The most commonly isolated organism was Pseudomonas aeruginosa. Conclusion: The results show that clinically, topical Bismuth Iodoform Paraffin Paste is more effective than topical levoxacin in this short time, besides; there is the benefit of low cost of therapy.

WITHDRAWN: Interventions for ear discharge associated with grommets (ventilation tubes).

The insertion of grommets (also known as ventilation or tympanostomy tubes) is one of the most common surgical procedures performed on children. Postoperative otorrhoea (discharge) is the most common complication with a reported incidence ranging from 10% to 50%. In the UK, many ENT surgeons treat with topical antibiotics/steroid combinations, but general practitioners, mainly through fears of ototoxicity, are unlikely to prescribe these and choose systemic broad-spectrum antibiotics. 1. To identify the most effective non-surgical management of discharge from ears with grommets in place.2. To identify the risks of non-surgical management for this condition (e.g. ototoxicity), and to set benefits of treatment against these risks. We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1966 to 2005) and EMBASE (1974 to 2005). We also searched the CINAHL, AMED, LILACS, ISI WEB OF KNOWLEDGE, ISI PROCEEDINGS, mRCT, NNR, ZETOC, KOREAMED, CSA, MEDCARIB, INDMED and SAMED databases. The date of the last search was February 2005. Randomised controlled trials of adults or children, with any type of grommet and an ear with discharge were included. The trials compared treatment with placebo or one treatment with another. The primary outcome measure was the duration of the discharge. The trials were selected independently according to the above criteria by the four reviewers. Differences in opinion over the inclusion of studies were resolved by discussion. The studies were graded using the CASP critical appraisal tool. Analyses were based on the presence of discharge seven days from the onset of treatment. There was very little good quality evidence. Four studies were included, all of them investigating different interventions and therefore a meta-analysis was not possible.Only one study demonstrated a significant difference. Oral amoxicillin clavulanate was compared to placebo in 79 patients. The odds of having a discharge persisting eight days after starting treatment was 0.19 (95% CI 0.07 to 0.49) . The number needed to treat to achieve that benefit is 2.5. Participants in both arms of this study also received daily aural toilet. The results will therefore not be applicable to most settings including primary care. No significant benefit was shown in the two studies investigating steroids (oral prednisolone with oral amoxicillin clavulanate and topical dexamethasone with topical ciprofloxacin ear drops), or the one study comparing an antibiotic-steroid combination (Otosporin®) drops versus spray (Otomize®) (although more patients preferred the spray form). The authors of this review have been unable to identify the most effective intervention or to assess the associated risks. Research is urgently needed into the effectiveness of oral versus topical antibiotics in this group of patients. Clinicians considering antibiotic treatment need to balance any potential benefit against the risks of side effects and antibiotic resistance.

Association of use of ear drops and sensori neural hearing loss: Cross sectional study

As we can cure the conductive deafness by surgery, the sensori neural deafness is still a challenge to us. Children having mixed loss of hearing invariably suffer from the point of view of education and development of language and therefore it becomes essential to study such cases so that we can prevent the sensori neural deafness in chronic suppurative otitis media. One hundred patients of chronic suppurative otitis media with sensori neural hearing loss, either alone or more commonly, with mixed loss were studied in this series. The patients were carefully selected after proper history and careful examination to exclude the above mentioned criteria to rule out the other possible causes of sensori neural loss. Though cases with use of ototoxic systemic drugs were rejected, cases with use of topical ear drops were included as their use was found to be common in chronic otitis media. The different ear drops used by patients showed large variety of nature of contents and varying period of use. Many patients could not inform the name of the drops they had used in past. In our study, use of topical antibiotic ear drops for long duration as a cause of sensori neural hearing loss was not statistically significant.