Title: Acute Otorrhea in Children with PE tubes<br/>Author: Jennifer Guyther<br/><a href='http://umem.org/profiles/faculty/314/'>[Click to email author]</a><hr/><p>
<span style="font-family: arial, sans-serif; font-size: 13px;">Up to 26% of patients with tympanostomy tubes (PE tubes) can suffer </span><span style="font-family: arial, sans-serif; font-size: 13px;">from clinically manifested otorrhea. This is thought to be the result of </span><span style="font-family: arial, sans-serif; font-size: 13px;">acute otitis media that is draining through the tube. Previous small </span><span style="font-family: arial, sans-serif; font-size: 13px;">studies suggested that antibiotic ear drops are as effective or more </span><span style="font-family: arial, sans-serif; font-size: 13px;">effective and with less side effects for its treatment. This study compared treatment </span><span style="font-family: arial, sans-serif; font-size: 13px;">with antibiotic/glucocorticoid ear drops </span><span style="font-family: arial, sans-serif; font-size: 13px;">(hydrocortisone-bacitracin-</span><wbr style="font-family: arial, sans-serif; font-size: 13px;" /><span style="font-family: arial, sans-serif; font-size: 13px;">colistin) to oral Augmentin (30 mg/kg/TID) </span><span style="font-family: arial, sans-serif; font-size: 13px;">to observation for 2 weeks.</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
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<span style="font-family: arial, sans-serif; font-size: 13px;">Study population: Children 1-10 years with otorrhea for up to 7 days </span><span style="font-family: arial, sans-serif; font-size: 13px;">in the Netherlands</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
<span style="font-family: arial, sans-serif; font-size: 13px;">Exclusion criteria included: T > 38.5 C, antibiotics in previous 2 </span><span style="font-family: arial, sans-serif; font-size: 13px;">weeks, PE tubes placed within 2 weeks, previous otorrhea in past 4 </span><span style="font-family: arial, sans-serif; font-size: 13px;">weeks, 3 or more episodes of otorrhea in past 6 months</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
<span style="font-family: arial, sans-serif; font-size: 13px;">Patient recruitment: ENT and PMD approached pt with PE tubes and they </span><span style="font-family: arial, sans-serif; font-size: 13px;">were told to call if otorrhea developed and a home visit would be </span><span style="font-family: arial, sans-serif; font-size: 13px;">arranged</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
<span style="font-family: arial, sans-serif; font-size: 13px;">Study type: open-label, pragmatic, randomized control trial</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
<span style="font-family: arial, sans-serif; font-size: 13px;">Primary outcome: Treatment failure defined as the presence of otorrhea </span><span style="font-family: arial, sans-serif; font-size: 13px;">observed otoscopically</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
<span style="font-family: arial, sans-serif; font-size: 13px;">Secondary outcome: based on parental diaries of symptoms, </span><span style="font-family: arial, sans-serif; font-size: 13px;">resolution and recurrence over 6 months</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
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<span style="font-family: arial, sans-serif; font-size: 13px;">Results: After 2 weeks, only 5% of the ear drop group compared to 44% </span><span style="font-family: arial, sans-serif; font-size: 13px;">of the oral antibiotic group and 55% of the observation group still </span><span style="font-family: arial, sans-serif; font-size: 13px;">had otorrhea. There was not a significant difference between those </span><span style="font-family: arial, sans-serif; font-size: 13px;">treated with oral antibiotics and those that were observed. Otorrhea</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
<span style="font-family: arial, sans-serif; font-size: 13px;">lasted 4 days in the ear drop group compared to 5 days with oral </span><span style="font-family: arial, sans-serif; font-size: 13px;">antibiotics and 12 days with observation (all statistically </span><span style="font-family: arial, sans-serif; font-size: 13px;">significant).</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
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<span style="font-family: arial, sans-serif; font-size: 13px;">Key differences: The antibiotic dosing and choice of ear drops are </span><span style="font-family: arial, sans-serif; font-size: 13px;">based on availability and local organism susceptibility.</span><br style="font-family: arial, sans-serif; font-size: 13px;" />
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<span style="font-family: arial, sans-serif; font-size: 13px;"><strong>Bottom line:</strong> For otorrhea in the presence of PE tubes, ear drops </span><span style="font-family: arial, sans-serif; font-size: 13px;">(with a non-aminoglycoside antibiotic and a steroid) may be more </span><span style="font-family: arial, sans-serif; font-size: 13px;">beneficial than oral antibiotics or observation.</span></p>
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<span style="font-family: arial, sans-serif; font-size: 13px;">van Dongen TM, van der Heijden GJ, Venekamp RP, Rovers MM, Schilder </span><span style="font-family: arial, sans-serif; font-size: 13px;">AG. A trial of treatment for acute otorrhea in children with </span><span style="font-family: arial, sans-serif; font-size: 13px;">tympanostomy tubes. N Engl J Med 2014; 370:723-33.</span></p>
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