Controlled trial of medical treatment of active chronic otitis media.

Abstract

Controlled trial of medical treatment of active chronic otitis media Active chronic otitis media is a common condition affecting 0 6%,' of adults in the United Kingdom. Initial management is usually by general practitioners, who annually prescribe systemic and topical antibiotics on at least 178 000 and 73 000 occasions respectively (unpublished observations). Despite this there have been few studies of the efficacy of antibiotics,'-4 and no study has included a control group of untreated patients or of patients treated solely by aural toilet. We undertook a controlled study comparing appropriate systemic or topical antibiotic treatment with weekly aural toilet and insufflation of boric acid and iodine powder.

Evidence-based management of otitis media: a 5S model approach

“…Systemic antibiotics seem less effective than topical antibiotics for reducing persistent otorrhoea after one to two weeks in adults 36 – 41 . Oral antibiotics and topical antiseptics seem equally more effective than topical antiseptics alone for reducing persistent discharge after two to four weeks in adults 37 . It is unclear which systemic antibiotic is more effective for reducing persistent otorrhoea 42 , 43 .…”

A randomised controlled trial of active chronic otitis media comparing courses of eardrops versus one‐off topical treatments suitable for primary, secondary and tertiary healthcare settings

“…Despite obvious concerns about using an ototoxic agent in ears, reported cases of hearing loss were rare 9 . Tong, Woo and van Hasselt 11 documented one case, and Kellerhals 12 conducted a questionnaire‐based survey amongst Swiss ENT surgeons reporting 15 cases of moderate–profound sensorineural hearing loss presumed associated with antibiotic eardrop use. He estimated the incidence to be 1/3000–1/1000.…”

“…However, this is contrary to the conclusions in the actual trial 19 which concluded that none of boric acid solution, topical aminoglycoside and systemic antibiotics had any advantage over aural toilet alone. Browning, Picozzi, Calder and Sweeney 11 studied boric acid and iodine powder and found it ineffective in COM, but their study included mastoid cavities. Other antiseptic agents tried include zinc peroxide powder, iodine powder and dilute methylated spirit eardrops 20 .…”

Evidence review and ENT‐UK consensus report for the use of aminoglycoside‐containing ear drops in the presence of an open middle ear

“…There are no RCTs comparing topical antiseptics versus placebo or no treatment. One RCT demonstrated no significant difference between topical antiseptics plus ear cleansing under microscopic control and either topical or oral antibiotics 7 . Another RCT found no significant difference in resolution of ear discharge between topical povidone–iodine and topical quinolone 8 .…”