Treatment Of Acute Otitis Externa Research Articles

Efficacy of 1.5% levofloxacin otic solution in treating acute otitis externa: A post hoc analysis of ENT103-3001, a multicenter randomized double-blind parallel-group placebo-controlled phase III study in otitis media with persistent otorrhea

ObjectiveIn this post hoc analysis, we aimed to evaluate the efficacy of 1.5% levofloxacin (LVFX) otic solution for the treatment of acute otitis externa (AOE) in patients with nonintact tympanic membrane (NTM) accompanied by chronic suppurative and acute otitis media. MethodsDigital endoscopic images of the tympanic membrane and cavity were evaluated. In addition, the full analysis set from the original ENT103-3001 study was analyzed to determine the efficacy of the 1.5% LVFX otic solution in treating patients with otitis media with persistent otorrhea. AOE was diagnosed by a study-specific blinded independent review committee (BIRC) in the present study, which reviewed the presence of inflammatory findings, such as edema, erosion, and/or erythema (redness), in the external ear canal on the digital endoscopic images acquired at screening. The improvement in the inflammatory findings in each diseased ear was evaluated by examining the digital endoscopic images acquired at the end of treatment (EOT; including study discontinuation) and follow-up (F/U) visits. Data regarding residual purulent otorrhea at EOT and F/U visits were assessed by the BIRC of the ENT103-3001 study. Similarly, otological symptoms at EOT were recorded in the patients’ diaries, and the bacterial eradication rates were used from the ENT103-3001 study. Improvement was defined as the resolution of the inflammatory findings and purulent otorrhea. ResultsAmong the 201 patients with otitis media, 161 patients had AOE (LVFX group, 82; placebo group, 79). The difference (95% confidence interval) between the groups at EOT was 27.3% (12.7, 40.3), and the proportion of patients showing improvement in all inflammatory findings in the external ear canal in the LVFX group (47.6%, 39/82) was significantly higher than that in the placebo group (20.3%, 16/79; Fisher's exact test, p < 0.001). Similarly, the bacterial eradication rate in the LVFX group (94.3%, 66/70) was also significantly higher than that in the placebo group (10.3%, 7/68; Fisher's exact test, p < 0.001). ConclusionThe use of 1.5% LVFX otic solution resulted in a significantly higher rate of improvement in inflammatory findings in the external ear canal and bacterial eradication rate, indicating its efficacy. Thus, 1.5% LVFX otic solution may be an effective treatment for chronic suppurative otitis media and acute otitis media, as well as AOE with NTM.

A Comparative Study on the Management of Acute Otitis Externa Using Hydroxylated Polyvinyl Acetate Ichthammol Glycerine Wick Versus Cotton Ichthammol Glycerine Wick.

Acute otitis externa is a localized inflammation of the skin of the external auditory meatus. It is characterized by pain, edema, erythema, and itchy discomfort. Treatment includes topical and oral antibiotics, analgesics, steroids, and anti-inflammatory medication for the ear. Aural medicated wicks are used to reduce edema and pain. To compare the clinical outcome of hydroxylated polyvinyl acetate ichthammol glycerine wick versus cotton ichthammol glycerine wick used in the treatment of acute otitis externa. It is a six-month observational study with 120 patients. The patients in this study were grouped into two groups with hydroxylated polyvinyl acetate and cotton wick, respectively. Pain was assessed using the VAS score before and after three days of treatment of acute otitis externa. Group B (patient treated with cotton ichthammol glycerine wick) had significant improvement in the pain score on days 2 and 3 compared to group A, with a significant p-value of <0.001. During the second visit (on day 2), the cotton ear wick was significantly better in terms of otalgia when compared with the hydroxylated polyvinyl acetate. The cotton wick group showed better and faster recovery in terms of pain and edema compared to the polyvinyl alcohol (PVA) groups.

Rapid Response to Gauze Strip Soaked in Triamcinolone, Neomycin, and Nystatin in Acute Otitis Externa

Background: Acute otitis externa (AOE) is a common condition with multiple available treatments. This study aimed to compare gauze strips soaked in triamcinolone, neomycin, and nystatin with conventional eardrops for the treatment of AOE. Methods: This experimental study included patients with AOE referred to the Otolaryngology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, 2014-2015. Based on their signs and symptoms, patients were divided into two clinical groups of mild to moderate and moderate to severe AOE. Patients treated with polymyxin B, neomycin, and hydrocortisone (polymyxin NH), or ciprofloxacin plus betamethasone eardrops were regarded as controls (conventional eardrops), and those whose ear canal had been filled with a gauze strip soaked in triamcinolone, neomycin, and nystatin (triamcinolone NN) were regarded as cases. Results: A total of 76 ears were included in this study (36 and 40 cases with mild to moderate and moderate to severe AOE, respectively). After 24 hours, in both clinical groups with mild to moderate and moderate to severe AOE, response to treatment with triamcinolone NN-soaked gauze strips was significantly higher than conventional eardrops (94.4% vs. 11.1%, P&lt;0.001 and 80% vs. 10%, P&lt;0.001, respectively). Conclusion: Patients with mild to severe AOE appear to rapidly respond to gauze strips soaked in triamcinolone, neomycin, and nystatin.

A Comparative Study of Antibiotic-steroid Pack with Glycerine Pack in Treatment of Acute Otitis Externa.

To compare the clinical efficacy of Antibiotic-Steroid pack with Glycerine pack for relieving pain and oedema in cases of acute otitis externa. A COMPARATIVE STUDY. Tertiary care center ( S.N.Medical college, Bagalkot). 20 patients clinically diagnosed with acute otitis externa. There were 10 patients in antibiotic-steroid pack group and 10 patients in glycerine group. There was female predominance in both the treatment groups and disease was most common in age group 12-20 years. There was no statistical significant decrease in pain and oedema in both the groups. But early reduction in sign and symptoms was noted in antibiotic-steroid group than glycerine group. Since the control of pain and edema is more and hence the number of visits is less in steroid-antibiotic packing group, so it is worthwhile to use steroid-antibiotic than glycerine pack.

Ways to increase compliance in patients with acute otitis externa

Topicality: The problem of diagnosis and treatment of otitis externa (OE) has been posed to doctors for a long time, and until the discovery of antibiotics (AB) and antifungal drugs (AFD) remained unresolved. OE can affect up to 10% of people at different periods of their lives, manifesting itself in the form of acute OE (AOE) in 95% of cases after the age of 2 years. There is a reduction in the number of patients admittance to the ENT specialist with the onset of the COVID-19 pandemic while maintaining the structure of the pathology, where AOE - in the top three of frequency. At the same time, there are a reports of an increasing amount of AOE cases in patients with COVID-19. Aim: To evaluate the dynamics of pain, the need for additional analgesia, systemic antibacterial therapy (ABT) or topical antifungal therapy (TAT), the level of compliance in patients with AOE in empirical treatment with a complex drug «Candibiotic» in comparison with protocol treatment. Material and methods: The study included adults and children from 2 years of age with a diagnosis of AOE: 30 patients in the main (17 adults, 13 children) and 25 patients in the control (15 adults, 10 children) groups. Patients in the main group as a basic treatment received topical ear drops «Candibiotic». Patients in the control group received protocol treatment. If necessary, patients were additionally prescribed analgesic therapy (ibuprofen in the appropriate dose), systemic ABT or TAT. For subjective pain asses, a visual analog scale (VAS) was used. Compliance was assessed using the Morisky-Green questionnaire. The obtained results were processed by common statistical methods. Results and discussion: In the main group of patients receiving «Candibiotic», there were fewer needs for additional systemic analgesia, systemic ABT, no one needed additional TAT. Comparison of the obtained results (percentage) in the form of arbitrary tables using the chi-squared test established that the relationship between factor and performance traits is not statistically significant (p&gt;0.05). The mean compliance score between the two study groups differed significantly as a whole and separately between the groups of adults and children (p&lt;0.05). Conclusion: In patients of adult and pediatric age with a diagnosis of AOE at the initial empirical appointment of the drug «Candibiotic» there was less need for additional analgesia, the appointment of systemic ABT and AFT. Such results did not differ statistically significantly from the results in adult and pediatric patients who were prescribed protocol treatment of AOE. Patients with «Candibiotic» monotherapy had a significantly higher average compliance score compared with the control group, especially among parents of children with AOE. The complex composition of ear drops «Candibiotic» contributes to a high adherence to treatment in patients, and the lack of an absolute analogue makes it the means of choice for the initial empirical treatment of AOE in adults and children over 2 years.

Steroid Antibiotic Pack Versus 10% Ichthammol Glycerol Pack in Management of Acute Otitis Externa: A Comparative Study

Acute otitis externa is a common clinical condition that presents with rapid onset of otalgia, fullness, otorrhea and canal oedema. Moisture in-ear canal appears to be an important predisposing factor. The most common etiological agents include Pseudomonas aeruginosa and Staphylococcus aureus. Management includes control of otalgia and elimination of infection from the ear. Precipitating factors should be avoided. The main objective of this study is to compare the efficacy of 10% ichthammol glycerol ear pack with steroid antibiotic ear pack in the treatment of acute otitis externa. Institutional Review Board (IRB) clearance was obtained, and a prospective randomised clinical trial was conducted in the ENT outpatient department of Saveetha Medical College &amp; Hospital, Thandalam, from January 2020 to March 2020. Patients were explained about the study in detail, and consent was obtained. The patients were randomised, and 10% ichthammol glycerol pack and steroid antibiotic pack were used in alternate turns for aural packing. Pain rating was done using Numerical rating scale (NRS) before and 48 hours post-treatment and also in each subsequent hospital visit till complete subsidence of symptoms. Among the 85 patients included in the study, 42 (49.4%) were males, and 43 (50.6%) were females. Most of them belonged to the age group 31-40 years (41.2%). Tragal tenderness and external auditory canal oedema were the most common ear findings noted. In the patients treated with steroid antibiotic pack, only 2.3% of the patients had severe pain, whereas 14% had moderate pain and 83.7% had only mild pain. Whereas among those treated with 10% ichthammol glycerol pack, 9.5% of the patients had severe pain, whereas 35.7% had moderate pain and 54.8% had mild pain. On analysis, the results were statistically significant, and there was considerable pain relief with steroid antibiotic pack. Therefore, our study showed that steroid antibiotic pack is more effective in relieving the symptoms, thereby reducing the number of hospital visits when compared to 10% ichthammol glycerol pack.

Effective pharmaceutical management of Acute Otitis Externa: guidance and prescribing considerations

Acute Otitis Externa is a common condition observed by physicians, particularly in primary care. The condition usually occurs due to bacterial infection, so antibiotic therapy is frequently indicated. Oral antibiotics are rarely necessary but are still being prescribed, despite a wide range of available topical preparations. Choosing a topical preparation can sometimes be challenging for prescribers, however, consideration of a range of different factors is necessary. This article provides a review of the currently recommended prescribing practice and outlines key topical antibiotic ear preparations available in the UK for treatment of Acute Otitis Externa. As no one topical ear preparation is more effective than another, a consideration of the benefits and risks of each treatment is needed to enable therapeutic resolution of Acute Otitis Externa. Furthermore, patient compliance should be adequately considered to increase the likelihood of patient adherence to treatment.

Is the Acidic pH of the External Auditory Canal Playing a Significant Role in the Treatment of Acute Otitis Externa?

Variable pH values for skin have been reported in the literature, all within the acidic range, varying from 4.0 up to 7. 0. The origin of the acidic pH remains conjectural, and several factors have been incriminated with this role, such as eccrine and sebaceous secretions as well as proton pumps. Keeping low levels of pH prevents microbial dispersal as well as multiplication. The skin in the external auditory canal is also covered with this acidic mantle with antimicrobial value. Changes of pH in the external ear can lead to acute otitis externa. This condition is defined by the inflammation and infection of the cutaneous and subcutaneous tissues of the external auditory canal. 10% of the world�s population may suffer from acute otitis externa at least once in their lifetime. This paper aims to consolidate the relevance of an acidic pH in the healthy external ear and its relation to the pathogenesis and treatment of otitis externa through a prospective and interventional clinical study on 80 patients who presented to the outpatient department at Prof. Dr D. Hociota ENT Institute in Buch

The Role of Topical Thymoquinone in The Treatment of Acute Otitis Externa: An Experimental Study in Rats

The Role of Topical Thymoquinone in The Treatment of Acute Otitis Externa: An Experimental Study in Rats

Acute Otologic Infections in Pediatric Patients

AbstractThis article summarizes significant acute infections involving the pediatric temporal bone. First, the management of acute otitis media (AOM) is discussed, including the medical and surgical management of invasive intracranial and extracranial complications associated with advanced disease. The clinical and radiographic findings, microbiology, and management of acute mastoiditis are discussed in greater detail, followed by the presentation and treatment of acute otitis externa (AOE). Finally, we discuss infectious considerations in auditory implants. The indications and use of both cochlear implants (CI) and bone conduction hearing implants have rapidly expanded in children, requiring greater understanding of managing infections in the context of these devices.

Povidone-iodine and glycerine for treatment of acute otitis externa

Introduction: Acute otitis externa (AOE) is the inflammation of the external ear. It usually presents with severe pain in the ear. The treatment of AOE should aim in relieving pain at the earliest. Out of the various treatment options, topical treatment should be considered as prescribing oral antibiotics without local treatment can cause antibiotic abuse. Due to unavailability, cost, and compliance issues of other topical measures, we observed and proved the effectiveness of a new modality glycerine and povidone-iodine wick in the treatment of AOE. Objectives: The objective of this study is to study the efficacy of new modality treatment-glycerine and povidone-iodine wick for AOE. Materials and Methods: Three hundred and forty-seven cases with AOE due to exclusive bacterial infection were included in the study. Otitis externa was graded as per Brighton grading scheme. Pain score was assessed using Wong and Baker pain assessment scale. Patients were treated by performing a thorough aural toilet, keeping a glycerine and povidone iodine wick in the EAC and prescribing a nonsteroidal anti-inflammatory drug. Few severe cases were administered the systemic antibiotic. Score of pain, canal edema, and the presence of ear fullness on D1, D3 (48 h later), and D5 was noted. Further assessment and repacking with a fresh wick was done if required until the pain and edema subsides completely. Results: It was seen that canal edema and tragal tenderness subsided significantly (P < 0.001) on follow-up visits. The severity of pain scale on D1 decreased significantly (P ≤ 0.001) on D3. On D3 or the first follow-up visit, 68 (19.5%) of patients required repacking, whereas there was no need for repacking on D5, i.e., second follow-up visit. Average duration of the clinical resolution was 3 days. Conclusions: The treatment method was readily available, easy to perform, cost-effective and had a better patient compliance. Povidone-iodine scores with no proven microbial resistance until date. To enhance delivery of drug locally specialist ear cleaning followed by wick insertion should be done. Use of glycerine and povidone-iodine ear pack is definitely effective with the good clinical outcome by 3 days maximum duration is 7 days. Use of oral antibiotics only for selected cases along with topical treatment for otitis externa is advisable. The outcome regarding pain relief and edema reduction were analyzed with satisfactory outcome at the earliest.

PD58 Cost-Effectiveness Of Quinolone For Acute External Otitis In Brazil

Introduction:In Brazil, the medicines marketed for acute external otitis are ciprofloxacin and the combination polymyxin B, neomycin, and fluocinolone. The aim of this study was to evaluate the proportion of cure and cost-effectiveness of quinolone versus polymyxin B, neomycin, and steroid combined (PNS) for acute external otitis from the perspective of the Brazilian Public health system.Methods:A systematic review was conducted using Medline, Cochrane Library, CRD and Lilacs databases. Studies evaluating quinolones versus PNS in the treatment of acute external otitis were included. A cost-effectiveness model was made using a decision tree, considering the direct cost of treatment. Univariate sensitivity analysis was conducted, considering the confidence interval of clinical outcomes and a 15 percent variation in cost.Results:The proportion of cure in up to 10 days was 70.1 percent with quinolone and 60.4 percent with PNS (p = 0.004). The treatment costs were BRL 16.22 (USD 5.02) with quinolone and BRL 3.04 (USD 0.94) with PNS. The incremental cost-effectiveness ratio was BRL 136.25 (USD 42.15) per cure in up to 10 days for quinolone in relation to PNS. This value was more sensitive to clinical outcomes, ranging from BRL 95.48 (USD 29.54) to BRL 254.25 (USD 78.65) for cure with quinolone and from BRL 90.77 (USD 28.08) to BRL 262.57 (USD 81.23) for cure with PNS. These values should be considered with caution because acute external otitis is resolved within a few days and treatment effectiveness is not measured by life years.Conclusions:There are few studies on therapeutic alternatives available in Brazil. Through the available evidence, there is a lack of results on the effects attributed to each drug. Considering the higher effectiveness, low cost and rational use of antibiotics, quinolone is considered a cost-effective alternative for acute external otitis in Brazil.

THE APPLICATION OF THE COMBINED DRUG POLIDEX IN THE THERAPY OF OTITIS EXTERNA OF VARIOUS BACTERIOLOGICAL ETIOLOGY

The article reflects the issues of epidemiology, etiology, pathogenesis and treatment of acute external otitis. A special emphasis in the work is made on the effectiveness of the modern combined drug Polidex in cupping this pathology.

Efficacy of Ichthammol Glycerin Pack and Steroid Antibiotic Pack as Initial Treatment of Acute Otitis Externa: A Comparative Study

Efficacy of Ichthammol Glycerin Pack and Steroid Antibiotic Pack as Initial Treatment of Acute Otitis Externa: A Comparative Study

Comparison of Boric Acid and Combination Drug of Polymyxin, Neomycin and Hydrocortisone (polymyxin NH) in the Treatment of Acute Otitis Externa.

Acute otitis externa is an inflammation of the external auditory canal known as "swimmer's ear". Direct costs including medical treatment, painkillers, antibiotics, steroids or both and indirect costs are also remarkable. The aim of this study was to compare the effect of boric acid and polymyxin, neomycin and hydrocortisone composition in the treatment of acute otitis externa. This randomized clinical trial was carried out on 80 patients aged more than 17-year-old who were referred to Kashani hospital clinic with a diagnosis of acute otitis externa by otolaryngologist. The patients were randomly allocated to two groups (A: Boric acid and B: polymyxin NH ear drops) and Painkiller was prescribed and administered orally for all patients and in the presence of fever, cellulitis around the ears and neck adenopathy, broad-spectrum systemic antibiotics were used besides topical treatment. Symptoms of patients who were evaluated by a physician includes pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching. In addition, pain was evaluated in patients and was recorded by Macgill Pain Questionnaire, in the first, third, seventh and tenth days. Results showed that itching on third day (p=0.007) and swelling of the ear canal in the examination of the third day (p=0.006) and the seventh day (p=0.001) in the polymyxin NH group was more than those of boric acid group. Overall mean pain based on McGill questionnaire was 11.10±1.49 in boric acid group in the examination on the first day and was 4.05±0.22 in the examination on the tenth day and in the polymyxin NH group, it was 10.9±0.99 on the first day and 4.20±0.40 on the tenth day. In both groups, pain relief was the same and there was no significant difference between two groups (p=0.075). The findings of this study showed slight differences in the effectiveness of the boric acid drug and combination of polymyxin, neomycin and hydrocortisone in the treatment of patients with acute otitis externa that is of clinical significance.

Finafloxacin: first global approval.

Finafloxacin is a fluoroquinolone antimicrobial agent that exhibits optimum efficacy in slightly acidic environments. It is being developed by MerLion Pharmaceuticals to treat serious bacterial infections associated with an acidic environment, including urinary tract infections and Helicobacter pylori infections. An otic suspension of finafloxacin (Xtoro™), developed by Alcon (a division of Novartis), was recently approved in the USA for the treatment of acute otitis externa, and a Common Technical Document for this indication was also filed in Canada. Oral and/or intravenous formulations are in phase I and II evaluation in uncomplicated urinary tract infections (Germany and Singapore), complicated urinary tract infections and pyelonephritis (Germany and Poland) and H. pylori infection (Germany). This article summarizes the milestones in the development of finafloxacin leading to this first approval for otitis externa.

Evidence-based treatment of acute otitis externa

Acute otitis externa (AOE), or diffuse inflammation of the external ear canal, causes a range of symptoms, including otalgia, otorrhoea, hearing loss and itching. Despite AOE being common, with a 12-month prevalence of approximately 1%, there is a paucity of evidence-based treatment guidelines. This contributes to a wide variation in its management, especially in general practice. In particular, there appears to be confusion over the roles of topical and oral antibiotics, as well as concerns about ototoxicity and the emergence of microbial resistance potentially caused by topical preparations. This article reviews the current evidence-based treatment of AOE.

Field Comparison of the Impact of Different Treatment Durations in the Treatment of Acute Otitis Externa

Background: Acute otitis externa is a common multi-factorial disorder in the dog. Several topical preparations are available on the veterinary market, which are licensed for an either specified duration of treatment or for a discretionary period that is determined by the clinician. Objectives: To compare the efficacy of two topical products, both licensed for the treatment of otitis externa in the dog, but with different treatment durations. Animal Population: One hundred and sixty dogs were enrolled in this multicentre field study from which 157 dogs were analysed in the Per Protocol sample (73 Aurizon?treated animals and 84 Easotic?treated animals). Method: Dogs were randomly assigned to Aurizon?or Easotic?treatment groups. Aurizon?(Vétoquinol SA: marbofloxacin, clotrimazole, dexamethasone) was administered daily in the affected ear(s) for 7 or 14 days, and was compared with a daily administration of Easotic?(Virbac SAS: gentamicin, miconazole, hydrocortisone aceponate) for 5 days. General and localised clinical signs were scored on days 0 (D0), 3 (D3), 7 (D7), 14 (D14) and 21 (D21). Results: Clinical cure rates at the end of treatment were 56.3% and 48.8% (p=0.35) in the Aurizon?and Easotic?groups respectively and 81.2% versus 74.7% one week after completing the course of treatment (p = 0.34). Twenty-one days after initially presenting for the study, cure rates were 84.3% in the Aurizon?group and 73.8% in the Easotic?(p=0.12). A relationship between severity of clinical signs and treatment duration was observed. Conclusion and Clinical Significance: At the end of the trial period, cure rates showed a tendency to be higher in the Aurizon?treated animals. The flexible dosage and the veterinary monitoring permitted treatment duration to be adjusted based upon the severity of otitis externa thus increasing the likelihood of clinical cure.

Investigation of the effectiveness of Syzygium aromaticum, Lavandula angustifolia and Geranium robertianum essential oils in the treatment of acute external otitis: A comparative trial with ciprofloxacin

Antibiotics and anti-inflammatory agents are the mainstay of acute external otitis (AEO) treatment. The present study investigated the effectiveness of a combination herbal drop (Lamigex) composed of essential oils from Syzygium aromaticum, Lavandula angustifolia, and Geranium robertianum in the alleviation of AEO symptoms and compared its effects to those of ciprofloxacin 0.3% drop. Seventy patients were randomly assigned to receive ciprofloxacin 0.3% (n = 35) or Lamigex (n = 35) drop. Each group was administered with three drops every 12 hours for a week. Patients were examined for AEO symptoms and ear discharge cultures at baseline as well as at the end of trial. Pain severity was also recorded using a visual analogue scale at baseline, the 3(rd) day, and the 7(th) day of the trial. All assessed symptoms (tenderness, itching, erythema, edema and discharge) were equally improved in the ciprofloxacin and Lamigex groups by the end of trial (p > 0.05). There were remarkable reductions in the visual analogue scale score by the end of trial in both groups (p < 0.001). However, the rate of pain improvement was not found to be significantly different between the groups, either at the 3(rd) or 7(th) day of trial (p > 0.05). The numbers of positive cultures for all tested microorganisms were clearly reduced by the end of the trial in both groups but were not significantly different between the groups (p > 0.05). The herbal combination drop that was investigated in the present study exhibited good efficacy in reducing the burden of infection as well as AEO symptoms.

Perspectives for new treatments at Alcon ‐ part 1

AbstractThis presentation will give the audience an overview of how we identify a wide variety of potential products to develop and how we condense this list down to the final candidates that will establish our pipeline strategy for each year. This process is conducted across the 3 main franchises of Alcon: Pharmaceuticals, Surgical and Vision Care. This presentation will review products in development in the areas of Glaucoma, Anterior Segment and the Ocular Surface. In the area of Glaucoma we currently have several products that will be reviewed. This includes potential new chemical entities with novel mechanisms of action and combination products that have the IOP lowering power greater than a beta‐blocker without the risk of a beta‐blocker. In the area of anterior segment we have several exciting programs in development to meet the unmet medical need around cataract surgery healing and post‐operative infection. In the area of the ocular surface we have several projects in development for improved treatment in allergy (both nasal and ocular) and dry eye. In addition, as an extension of this area, we have projects for the treatment of acute otitis externa and antibacterial use during the peri‐operative placement of tympanostomy tubes.