Tube Otorrhea Research Articles

Decreasing Telephone Calls for Tympanostomy Tube Otorrhea: A Pilot Study.

The "Clinical Practice Guideline: Tympanostomy Tubes in Children" published in 2013 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation encourages that an "educational video, or other teaching aid, should be developed to illustrate how parents/caregivers" may manage postoperative complications such as tube otorrhea; however, the current literature is devoid of such patient safety and quality improvement measures. Our objective was to develop an effective educational model to assist parents and caregivers in understanding the signs and symptoms of tympanostomy tube (TT) otorrhea and how to independently institute the appropriate otologic treatment. A 3.5 × 2-inch instructional card was designed to illustrate TT otorrhea and describe the subsequent steps necessary to obtain and institute the appropriate medical therapy. This was distributed to caregivers of all patients undergoing TT placement in September 2016; patients undergoing TT placement in May 2016 served as the preintervention control cohort. Group comparisons were made before and after implementation of the educational model by number of telephone calls our clinic triaged regarding untreated TT otorrhea, as documented within the electronic medical record. A total of 30 sets of TT were placed in September 2016, compared to 27 sets of TT in May 2016. Postoperatively, a run chart revealed a significant shift (ie, 7 consecutive points) in the number of telephone calls received (16-5 calls) after establishment of the proposed educational model. This clinical experience demonstrates the utility of patient-driven management of TT otorrhea through ancillary educational material. Given the superiority of topical otic therapy, continued translation efforts are needed for continued focus on practice implementation and dissemination.

Tympanostomy tube otorrhea in children: prevention and treatment.

One in two children treated with tympanostomy tubes, experience episodes of otorrhea whilst their tubes are in place. In this review, we present the results of the most recent publications on prevention and treatment of tympanostomy tube otorrhea (TTO). Recent systematic reviews on water precautions for children with tympanostomy tubes support the American Academy of Otolaryngology - Head and Neck Surgery guideline recommendation against such preventive measures as there is no evidence that it protects against TTO. Studies on tympanostomy tube design and material suggest that silicone tubes have a lower TTO risk and that biofilms appear to be mainly located in the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Another study shows that the biofilm-component DNAB-II protein is present in otorrhea of half of children with TTO. Targeting this protein could lead to a collapse of the biofilm structure and as such a potential new treatment for chronic TTO. New systematic reviews show that antibiotic eardrops are the most effective first-line treatment of acute TTO and suggest that an antibiotic-corticosteroid combination is more effective than antibiotic only. Although in many countries, quinolone eardrops are the preferred choice because of being non-ototoxic, one study found a higher risk of persistent perforation after tube extrusion in children treated with quinolone eardrops as compared with children treated with aminoglycoside eardrops. Recent evidence confirms that water precautions for children with tympanostomy tubes are not effective in preventing TTO. Antibiotic-corticosteroid eardrops are the most effective treatment of acute TTO.

A newly designed tympanostomy stent with TiO2 coating to reduce Pseudomonas aeruginosa biofilm formation

Biofilm formation has been implicated as a cause of post-tympanostomy tube otorrhea in patients suffering from otitis media with effusion, and biofilms have been found to adhere to all available types of tympanostomy tubes (TT) made from silicone. In this study, we present a novel stent designed with a reduced surface area and a titanium dioxide (TiO2) coating to prevent biofilm formation. Using a radio frequency power supply, tympanostomy stents (TS) made from Nitinol (Nikel-titanium) were coated with TiO2 to form an oxide layer on the metallic target. We successfully reproduced biofilms with carbenicillin-resistant Pseudomonas aeruginosa strain, PAO1-GFP (green fluorescent protein) on the tubes in vitro. We then compared the levels of biofilm formation by this strain on the two types of implants using several methods, including bacterial quantification, electron microscopy, and confocal laser fluorescent microscopy. Our results provide definitive evidence that the combination of the TiO2 coating and minimized surface area of the Nitinol stent inhibited the P. aeruginosa biofilm formation. The ability of the TS to prevent viable bacteria colonization (over 10 folds, compared to silicone TT) was verified by anti-biofilm test. Future studies will reveal more useful in reducing otorrhea and plugging complications as a novel tympanostomy tube.

Prospective observational case series evaluating middle ear fluid and tympanostomy tubes through pyrosequencing

ObjectiveOne of the most common sequelae of tympanostomy tube (TT) placement is post-tympanostomy tube otorrhea (PTTO). Granulation tissue formation has been reported in 5–13.8% of patients with TT placement. The purpose of this study is to determine the biodistribution of microorganisms on TTs and middle ear fluid obtained from patients with PTTO. MethodsThis was a prospective observational study of subjects (6-months–16-years) who underwent standard of care treatment for chronic PTTO. Data was collected on diagnosis, existence of antibiotic resistance, duration of tube placement, and evidence of recurrent infection and/or PTTO. TTs and middle ear fluid were subjected to pyrosequencing; additionally, ear fluid samples were sent for culture-based laboratory diagnostics. ResultsDNA-pyrosequencing analysis of bacteria from fluid and TTs of pediatric subjects with PTTO revealed a mixture of both aerobic and anaerobic populations. Retained tubes with minimal otorrhea revealed a predominance of Staphylococcus species, normal external auditory canal (EAC) microbiome, within middle ear fluid as well as on TTs. However, TTs with active mucopurulent otorrhea and granulation tissue unveiled prominence of Gram-negative facultative anaerobes such as Pseudomonas and Eikenella. Discrepancies in prominent bacteria were seen between standard culture-based techniques versus pyrosequencing. ConclusionRetained tympanostomy tubes are colonized primarily with normal flora of the EAC. However, mucopurulent otorrhea associated with granulation tissue formation revealed a prominence of Gram-negative facultative anaerobes. Standard culture-based diagnostics may identify bacteria, which are not predominant species of infection. Future studies are necessary to assess the association of Gram-negative facultative anaerobes with granulation tissue formation.

Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone.

To describe the presentation, surgical findings, and outcomes in patients with spontaneous temporal bone cerebrospinal fluid (CSF) fistulas and encephaloceles. Retrospective chart review. A retrospective chart review of patients treated for a spontaneous temporal bone CSF fistula and/or encephalocele over a 10-year period was performed. Data recorded included demographic information, presenting signs and symptoms, radiographic and laboratory studies, surgical approach, materials used for repair, surgical complications, and successful closure of the CSF fistula. Fifty patients were identified. Five patients underwent bilateral procedures, for a total of 55 surgical repairs. Thirty-seven of the patients were female, with a mean age of 57.2 years. Seventy percent of patients were obese, with a mean body mass index of 35.0 kg/m2 . The most common presentation was tympanostomy tube otorrhea (68%). Seven patients (14%) presented with meningitis. The middle fossa craniotomy approach was used in 87.3% of cases. Hydroxyapatite bone cement was used in 82.4% of cases. There were four surgical complications: seizure, mastoid infection, tympanic membrane retraction, and a delayed subdural hematoma. There were five persistent or recurrent CSF fistulas that underwent successful revision surgery. Spontaneous CSF fistulas are most common in obese females and should be suspected with a chronic middle ear effusion, persistent otorrhea after tympanostomy tube placement, or in patients with a history of meningitis. The middle fossa craniotomy approach with the use of hydroxyapatite bone cement has a high success rate with a low incidence of postoperative complications. 4 Laryngoscope, 128:2170-2177, 2018.

Efficacy of topical 2% mupirocin ointment for treatment of tympanostomy tube otorrhea caused by community-acquired methicillin resistant Staphylococcus aureus

ObjectiveTo demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA). MethodsWe treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/− ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared. Results29 children (37 ears) with MRSA TTO were included. 8 children (12 ears) received adjunctive topical mupirocin ointment – 21 children (25 ears) did not. 8 of 12 ears in the mupirocin group received concomitant systemic antibiotics – 4 ears were treated with topical mupirocin alone. The mean duration of follow-up of the mupirocin group was 7 months (with 95% C.I of 7 ± 7). The control group was 24 months (with 95% C.I of 24 ± 9). Recurrence of MRSA TTO in the mupirocin and control groups were 0/12; 0% and 10/25; 40%, by ear, respectively (p = 0.015). Recurrence of non-MRSA TTO in the mupirocin and control groups were 6/12; 50% and 9/25; 36%, by ear, respectively (p = 1.0). There were no sensorineural hearing losses in the mupirocin-treated children. ConclusionIn this small series, a single application of topical mupirocin in combination with mechanical debridement, controlled infection by CA-MRSA without evidence of local reaction or subsequent hearing loss. Its role in treatment of MRSA TTO merits further investigation.

In Vitro Susceptibility of Ciprofloxacin-Resistant Methicillin-Resistant Staphylococcus aureus to Ototopical Therapy.

Objective Despite the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) otologic infections, choice of treatment remains controversial. Only fluoroquinolone-containing ototopical preparations are approved by the US Food and Drug Administration for middle ear application. Furthermore, American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines advocate ototopical monotherapy for both tympanostomy tube otorrhea and acute otitis externa. Unfortunately, MRSA may be ciprofloxacin resistant. This causes confusion regarding antibiotic selection, because susceptibility profiles reflect a minimum inhibitory concentration (MIC), referenced against systemic, not ototopical, drug delivery dosing. The goal of this study is to determine the ciprofloxacin MIC for ciprofloxacin-resistant MRSA isolates from otologic infections and compare that value to the expected drug concentration achieved by fluoroquinolone ear drops and determine MRSA genotype for each isolate. Study Design In vitro assay with retrospective medical record review. Setting Tertiary care university hospital. Subjects and Methods Thirty otologically sourced ciprofloxacin-resistant MRSA isolates collected from adult and pediatric patients. MICs were calculated by broth dilution method. Isolates underwent multilocus sequence typing and polymerase chain reaction for arcA and Panton-Valentine leukocidin to establish the genotype. Results MICs ranged from 16 to 1025 µg/mL. There was a relationship between MIC and genotype; of the 7 isolates with an MIC value greater than 512 µg/mL, 6 were sequence type (ST)8. Conclusion These findings support the practice of ototopical monotherapy for patients with uncomplicated ciprofloxacin-resistant MRSA otitis externa. However, they raise concern that ototopical therapy may not be adequate to treat highly resistant strains of MRSA infecting the middle ear space.

The Relation between Tympanostomy Tube Otorrhea and Types of Immune Cells in Middle Ear Effusion in Children with Otitis Media with Effusion

The Relation between Tympanostomy Tube Otorrhea and Types of Immune Cells in Middle Ear Effusion in Children with Otitis Media with Effusion

Second tympanostomy tube placement in children with recurrent acute otitis media.

To determine the rate and predictors of electing for a second bilateral myringotomy and tympanostomy tube placement (BMT) in children with recurrent acute otitis media (RAOM). Retrospective chart review. Charts of 600 children who underwent BMT for RAOM between 2012 and 2014 were reviewed. The overall rate of a second BMT was 15.2% (91/600) and occurred a median of 1.58 years after the initial BMT. The most common indication was continued RAOM with extruded tubes. There was a higher rate of second BMT in patients of younger age (1.06 vs. 1.32 years old, P < .001) and those with a positive family history of RAOM/BMT in a first-degree relative (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.02-2.73, P = .041). Identification of middle ear fluid intraoperatively (OR: 1.99, 95% CI: 1.22-3.26, P = .005) but not preoperatively (OR: 1.88, 95% CI: 0.98-3.57, P = .051) was associated with higher rates of second BMT. Children with bilateral intraoperative fluid (OR: 2.25, 95% CI: 1.42-3.58, P < .001) or fluid both preoperatively and intraoperatively (OR: 2.25, 95% CI: 1.40-3.61, P = .001) had greater higher risk of requiring second BMT. In this series, the finding of blocked tubes or tube otorrhea at the first postoperative visit were not predictive of an increased risk of second BMT. Children who underwent BMT for RAOM were more likely to undergo second BMT if they were of younger age, had a family history of RAOM/BMT, or were found to have middle ear fluid intraoperatively. The overall second BMT rate for children with RAOM is lower than in studies examining all BMT indications. 4. Laryngoscope, 128:1476-1479, 2018.

Prevention and Treatment of Tympanostomy Tube Otorrhea: A Meta-analysis.

Children with tympanostomy tubes often develop ear discharge. Synthesize evidence about the need for water precautions (ear plugs or swimming avoidance) and effectiveness of topical versus oral antibiotic treatment of otorrhea in children with tympanostomy tubes. Searches in Medline, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature. Abstracts and full-text articles independently screened by 2 investigators. 25 articles were included. One randomized controlled trial (RCT) in children assigned to use ear plugs versus no precautions reported an odds ratio (OR) of 0.68 (95% confidence interval, 0.37-1.25) for >1 episode of otorrhea. Another RCT reported an OR of 0.71 (95% confidence interval, 0.29-1.76) for nonswimmers versus swimmers. Network meta-analyses suggest that, relative to oral antibiotics, topical antibiotic-glucocorticoid drops were more effective: OR 5.3 (95% credible interval, 1.2-27). The OR for antibiotic-only drops was 3.3 (95% credible interval, 0.74-16). Overall, the topical antibiotic-glucocorticoid and antibiotic-only preparations have the highest probabilities, 0.77 and 0.22 respectively, of being the most effective therapies. Sparse randomized evidence (2 RCTs) and high risk of bias for nonrandomized comparative studies evaluating water precautions. Otorrhea treatments include non-US Food and Drug Administration approved, off-label, and potentially ototoxic antibiotics. No compelling evidence of a need for water precautions exists. Cure rates are higher for topical drops than oral antibiotics.

Panel 7: Otitis Media: Treatment and Complications.

Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.

Infectious complications of pediatric cochlear implants are highly influenced by otitis media

ObjectiveDetermine the incidence of ear infections in cochlear implant patients, evaluate the contribution of otitis media to complications, describe the bacteriology of otitis media in the cochlear implant population, the treatment provided at our center, and the long term outcome. MethodsData collected included age at implantation, history of otitis media or ear tubes, etiology of hearing loss, inner ear anatomy, postoperative infections, time to infection, route of antibiotic administration, and interventions for infections. Categories of infection were acute otitis media, otitis media with effusion, tube otorrhea, meningitis, scalp cellulitis, and infection at the implant site. ResultsMiddle ear infections were diagnosed in 37% of implanted ears. Extension of middle ear infections into the implant site occurred in 2.8% of all implants (n = 16). Of the 16 infected devices, 10 were successfully treated with antibiotic therapy and did not require explantation. The retained implant group and explanted group both included some middle ear microbes such as Haemophilus influenzae and Streptococcus pneumoniae, as well as skin flora such as Staphylococcus aureus. ConclusionOtitis media in pediatric cochlear implant patients is a common event and usually does not lead to complications of the cochlear implant. However, when the ear infection spreads to the scalp and the implant site, it is still possible to eliminate the infection using antibiotic therapy, particularly when treatment is directed to the specific organism that is recovered from the infected space and the duration and route of antibiotic treatment is carefully considered.

Planktonic Growth of Pseudomonas aeruginosa around a Dual-Species Biofilm Supports the Growth of Fusobacterium nucleatum within That Biofilm.

Purpose The goal of this study was to understand the potential interaction between Pseudomonas aeruginosa and Fusobacterium nucleatum within the middle ear. MethodsWe examined the microbiota of ear fluid and tympanostomy tubes (TTs) obtained from patients with posttympanostomy tube otorrhea. We also examined biofilms formed by P. aeruginosa and F. nucleatum, singly or together, under aerobic or anaerobic conditions. Results While the facultative anaerobe P. aeruginosa dominated the bacterial population within the ear fluid, strict anaerobes, including F. nucleatum, dominated bacterial populations within the TTs. F. nucleatum was able to grow under aerobic conditions only in the presence of P. aeruginosa, whose growth reduced the level of dissolved oxygen within the broth to nearly anoxic condition within 4 h after inoculation. The presence of P. aeruginosa allowed F. nucleatum to maintain its growth for 72 h within the dual-species biofilm but not within the planktonic growth. Visualization of the biofilms revealed coaggregation of P. aeruginosa and F. nucleatum. Conclusion Extrapolation of these results suggests that, within the middle ear fluid, the growth of P. aeruginosa produces the anaerobic conditions required for the growth of F. nucleatum, both within effusion and within biofilms.

The impact of tobacco exposure on development of otorrhea after myringotomy tube placement

IntroductionOtorrhea is a common sequela after myringotomy with tube placement (MTP). The purpose of this study was to identify any significant relationship between passive tobacco exposure and the development of post-tympanostomy tube otorrhea. MethodsRetrospective chart review was performed on 774 cases of patients who underwent MTP by a single surgeon at a tertiary pediatric hospital from 2012 to 2014. Patients with multiple medical comorbidities, craniofacial anomalies, syndromes and those over 12 years of age were excluded. Multivariate logistic regression analysis was performed to determine if there was a relationship between risk factors (including tobacco exposure, age, pre-operative diagnosis, operative findings and duration of follow-up) and the development of post-tympanostomy tube otorrhea. ResultsOne hundred and ninety-one patients (average age of 1.92 years) were included. Overall, 16.8% of patients (32/191) had exposure to tobacco smoke. Of patients with passive smoke exposure, 65.6% (21/32) developed otorrhea, as compared to 45.3% (72/159) of those without tobacco exposure. Passive exposure to tobacco smoke by (OR = 2.307; p = 0.009; 95% CI, 1.734–6.028) and younger age (p = 0.012; 95% CI, 0.602–0.938) were associated with increased risk for otorrhea. DiscussionThis study suggests that in a cohort of patients undergoing MTP, passive exposure to tobacco smoke significantly increases the risk of developing post-operative otorrhea. This information is valuable to include in parental preoperative counseling regarding tympanostomy tube placement.

Topical versus oral antibiotics, with or without corticosteroids, in the treatment of tympanostomy tube otorrhea

ObjectiveAntibiotic treatment is the standard of care for tympanostomy tube otorrhea. This meta-analysis aims to evaluate the efficacy of topical antibiotics with or without corticosteroids versus oral antibiotics in the treatment of tube otorrhea in children. Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and ProQuest. Review MethodsThe above databases were searched using a search strategy for randomized controlled trials for optimal treatment of tube otorrhea in the pediatric population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Primary outcome was cure (i.e. clearance of otorrhea) at 2–3 weeks. Secondary outcomes were microbiological eradication and complications such as dermatitis and diarrhea. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) and number needed to benefit (NNTB) in a random-effects model. ResultsWe identified 1491 articles and selected 4 randomized controlled trials which met our inclusion criteria. Topical treatment had better cure (NNTB = 4.7, pooled RR = 1.35, p < 0.001) and microbiological eradication (NNTB = 3.5, pooled RR = 1.47, p < 0.001 among 3 of the studies) than oral antibiotics. Oral antibiotics had higher risk of diarrhea (pooled RR = 21.5, 95% CI 8.00–58.0, p < 0.001, Number needed to harm (NNTH) = 5.4) and dermatitis (pooled RR = 3.14, 95% CI 1.20–8.20, p = 0.019, NNTH = 32). The use of topical steroids in addition to topical antibiotics was associated with a higher cure rate (pooled RR = 1.59, p < 0.001 vs pooled RR = 1.57, p = 0.293). ConclusionTopical antibiotics should be the recommended treatment for management of tympanostomy tube otorrhea in view of its significantly improved clinical and microbiological efficacy with lower risk of systemic toxicity as compared to oral antibiotics. Further research is necessary to confirm the benefits of topical corticosteroids as an adjunct to topical antibiotics.

Identification of biofilms in post-tympanostomy tube otorrhea.

Otitis media is a common problem in the pediatric population. Despite antibiotic therapy, post-tympanostomy otorrhea can be difficult to treat. Biofilms have been shown to play a role in chronic and recurrent otitis media and are implicated in otorrhea. This study investigated both the microbial composition and the presence of biofilm fragments rich in extracellular DNA (eDNA) and the bacterial DNA-binding protein, integration host factor (IHF), in post-tympanostomy tube otorrhea. Clinical samples. Institutional review board approval was obtained, and samples were recovered from pediatric patients with tympanostomy tubes and persistent otorrhea for both microbial culture and biofilm analysis. For biofilm assessment, frozen samples were sectioned and then labeled using a rabbit anti-IHF, which was detected with goat anti-rabbit IgG conjugated to AlexaFluor 594. Samples were then counterstained with 4',6-diamidino-2-phenylindole (DAPI) to detect DNA, and images were captured by inverted light microscopy. Of 15 pediatric otorrhea samples analyzed, nine (60%) contained solids that were positive for labeling of IHF in association with a lattice of eDNA, and 75% yielded positive bacterial cultures. Bacterial culture results included H. influenzae, Methicillin-resistant Staphylococcus aureus, S. pneumoniae, M. catarrhalis, and P. aeruginosa. Positive labeling of otorrhea solids for eDNA and IHF, in combination with microbiological culture results, indicated that biofilms likely played a key role in chronic otorrhea. Moreover, as a known critical structural component of biofilms, these findings suggest that DNABII proteins in association with eDNA may serve as an important therapeutic target in post-tympanostomy tube otorrhea. NA. Laryngoscope, 126:1946-1951, 2016.

Complications of tympanostomy tubes in head and neck cancer patients

PurposeTo assess myringotomy plus tympanostomy tube (MTT) complication rates in head and neck cancer (HNC) patients with otitis media (OM). Materials and methodsWe performed a retrospective review of 182 HNC patients with OM treated between January 2000 and October 2007 for demographic data and data about MTT-related complications, tumor type and outcomes following MTT. ResultsWe identified OM in 35 nasopharyngeal (NP), 34 paranasal sinus (PNS), and 24 larynx cancer patient ears; of these, 29 (83%), 31 (91%), and 22 (92%), respectively, were treated with MTT. Of the 29 NP cancer patient ears treated with MTT, 13 (45%) received MTT before radiotherapy; complications included otorrhea in 11 ears (38%), otorrhea with perforation in 3 ears (10%), and cholesteatoma in 1 ear (3%). Of the 31 PNS cancer patient ears treated with MTT, 17 (55%) received MTT before radiotherapy; complications included otorrhea in 10 ears (32%) and otorrhea with perforation in 3 ears (10%). All 22 laryngeal cancer patient ears were treated with MTT before radiotherapy; 5 ears (23%) developed chronic otorrhea. Patients with pre-existing eustachian tube dysfunction had significantly higher rates of tympanostomy tube otorrhea (p=.009). ConclusionsThe complication rates of OM in the setting of NP or PNS cancer were not significantly different regardless of intervention timing in relation to radiotherapy. Laryngectomy patients had a high rate of tympanostomy sequelae after radiotherapy. MTT for OM has high complication rates in HNC patients.

Randomized Clinical Trial of a Sustained-Exposure Ciprofloxacin for Intratympanic Injection During Tympanostomy Tube Surgery.

Objective:This exploratory clinical trial evaluated the safety and clinical activity of a novel, sustained-exposure formulation of ciprofloxacin microparticulates in poloxamer (OTO-201) administered during tympanostomy tube placement in children.Methods:Double-blind, randomized, prospective, placebo- and sham-controlled, multicenter Phase 1b trial in children (6 months to 12 years) with bilateral middle ear effusion requiring tympanostomy tube placement. Patients were randomized to intraoperative OTO-201 (4 mg or 12 mg), placebo, or sham (2:1:1 ratio).Results:Eighty-three patients (52 male/31 female; mean age, 2.80 years) were followed for safety (otoscopic exams, cultures, audiometry, and tympanometry) and clinical activity, defined as treatment failure (physician-documented otorrhea and/or otic or systemic antibiotic use ≥3 days post surgery). At baseline, 14.3% to 36.8% of children showed positive cultures of middle ear effusion samples in at least 1 ear. Through day 15, treatment failures accounted for 14.3%, 15.8%, 45.5%, and 42.9% of patients (OTO-201 4 mg, OTO-201 12 mg, placebo, and sham, respectively); treatment failure reductions for OTO-201 doses were significant compared to pooled control (P values = .023 and .043, respectively). Observed OTO-201 safety profile was indistinguishable from placebo or sham.Conclusions:Results of this first clinical trial suggest that OTO-201 was well tolerated and shows preliminary clinical activity in treating tympanostomy tube otorrhea.

Can curcumin prevent the formation of Pseudomonas aeruginosa biofi lm on the surface of tympanostomy tubes?

Formation of bacterial biofilm on the surface of tympanostomy tubes are held responsible in the pathogenesis of post-tympanostomy tube otorrhea. To prevent the formation of biofilm, various methods were employed and varying degrees of success have been achieved. In some recent studies curcumin, which is the fenolic form of Curcuma longa (turmeric), has been pointed out to have inhibitory effects on virulence factors of Pseudomonas aeruginosa. The aim of this study was to investigate whether the administration of curcumin is able to prevent the formation of P.aeruginosa biofilm on the surface of silicone tympanostomy tubes in vitro conditions. For this purpose, qualitative and quantitative analysis of P.aeruginosa biofilm created on the surface of the tympanostomy tubes were performed following a period of 48 hours incubation in microplate wells that contained decreasing concentrations of curcumin. For qualitative analysis, specimens were evaluated with an environmental scanning electron microscope for the existence of biofilm. For the quantitative analysis, bacteria attached to the tube surface was detached using a combination of vortexing and sonication. Following serial dilutions, the obtained solution was then inoculated on the sheep blood agar plates using calibrated loop, incubated for 24 hours and the colony forming unit (CFU) per mL were recorded. Environmental scanning electron microscope analysis revealed that 100 µg/mL of curcumin could prevent formation of the biofilm. Lower concentrations of curcumin could not prevent the biofilm formation. Qualitative analysis also revealed that when the concentrations of curcumin in the wells were decreased, the number of CFU/mL was increased significantly. Mean number of CFU in 100 µg/mL and 12.5 µg/mL groups were 35±7.07 and 650±494, respectively. Curcumin could prevent formation of P.aeruginosa biofilm on the surface of tympanostomy tubes in vitro with concentrations lower than the MIC value. The results of the present study show that local administration of curcumin may prevent suppurative otitis media following tympanostomy tube insertion, keep the patency of the tube and decrease the rate of treatment failure. In vivo studies are needed to support the in vitro anti-biofilm action of curcumin on tympanostomy tubes.

The rationale for preventive treatments for early post-tympanostomy tube otorrhea in persistent otitis media with effusion.

Some studies have shown that post-tympanostomy tube otorrhea (PTTO) is a common complication after tympanostomy tube insertion. There are wide range of controversies about the incidence of PTTO and different methods of preventive treatment. The aim of this study was to determine the incidence of early PTTO in persistent otitis media with effusion in our centers. We also investigated the effect of preventive treatments on the incidence of early PTTO in children with persistent otitis media with effusion. This multi-central study comprised 536 ears belonging to children with otitis media and effusion for at least 3 months, referred for complications arising from post-tympanostomy tube insertion. The patients were randomly divided into three treatment and control groups. In the first group of patients, the middle ear cavity was irrigated with isotonic saline after myringotomy. The second group received oral amoxicillin three times a day for 7days postoperatively. The third group had similar treatment as the second group, in addition to topical ciprofloxacin drop, 4 drops three times a day for 3days after operation. The control group did not undergo any treatment. Early post-tympanostomy tube otorrhea was detected in 6 ears (1.1%), including 3 (2.2%) from the control group and 3 (2.3%) from the first group. There was no statistically significant difference in early PTTO between integrated treatment groups and control group (P=0.111). As the total rate of early post-tympanostomy tube otorrhea was very low, there was no significant difference between the 3 treatment groups and control group. Our study did not support the routine use of preventive therapy. A period of at least 3months watchful waiting before tympanostomy tube insertion may help reduce the incidence of PTTO.