In vitro and in vivo evaluation of change of local pH on bacteria in C.S.O.M

Role of Acetic Acid Irrigation in Medical Management of Chronic Suppurative Otitis Media: A Comparative Study

Chronic otitis media is persistent and insidious disease. It is one of the most common bacterial infections in the field of otolaryngology having significant economic and individual repercussion. Medical management of chronic suppurative otitis media (CSOM) for dry ear is essential before surgical treatment. The objective is to consider the most appropriate medical treatment modalities for patients of CSOM. To assess results of acetic acid irrigation and topical and systemic antibiotic in CSOM and consider, the most appropriate medical management. This study was conducted prospectively from Nov 2011 to Sep 2013 in 100 patients of CSOM (tubotympanic type). Patient included in the present study were divided in two groups. In one group patients were treated with aural toilet and irrigation with acetic acid and in other group patients were treated with topical and systemic antibiotic. After a follow up period of 3 months duration results were assessed on the basis of absence of discharge, healing of perforation and status of middle ear. Otorrhoea resolution in group treated with acetic acid was 84 % and healing of perforation was noted in 26 % while failure rate of 16 % was noted. In group treated with topical and systemic antibiotic 58 % of patient shows otorrhoea resolution, 14 % achieve healing of perforation and 32 % had failure. Medical management of CSOM without Cholesteatoma by frequent aural cleaning and irrigation using dilute acetic acid can be more desirable choice as compared to the topical and oral antibiotics.

Prospective randomised single-blind controlled trial of glacial acetic acid versus glacial acetic acid, neomycin sulphate and dexamethasone spray in otitis externa and infected mastoid cavities

OBJECTIVES

The literature reports the merits of antibacterial, antibiotic and steroid agents in treating otological infections but no controlled clinical trial has directly compared 2% glacial acetic acid (EarCalm; Stafford-Miller Ltd, Brentford, UK) against 2% glacial acetic acid, 0.1% dexamethasone and 3250 U/ml of neomycin sulphate (Otomize; Stafford-Miller Ltd) in the treatment of otitis externa and infected mastoid cavities.

DESIGN

Prospective, single-blind randomised controlled trial.

SETTING

Outpatients, Derby Royal Infirmary, Derby, UK.

PATIENTS

Emergency and GP referrals with acute otitis externa (n = 53) and infected mastoid cavities (n = 56).

MAIN OUTCOME MEASURES

Otoscopy was performed at initial randomisation and then at 2 and 4 weeks, the ear assessed for active and inactive disease.

RESULTS

Patients with active otitis externa, 71% (15/21) resolved with glacial acetic acid, dexamethasone and of neomycin sulphate after 2 weeks, increasing to 86% (18/21) after 4 weeks treatment. Patients on glacial acetic acid had only 38% (12/32) resolution after 4 weeks (P < 0.0005). Two per cent glacial acetic acid, dexamethasone and neomycin sulphate resolved only 30% (8/27) of infected mastoid cavities compared to only 10% (3/29) on glacial acetic acid (P < 0.07). A further 2 weeks treatment this increased to 67%, (18/27) with glacial acetic acid, dexamethasone and neomycin sulphate and 48% (14/29) with glacial acetic acid. These results are not statistically significant.

CONCLUSION

Glacial acetic acid, dexamethasone and neomycin sulphate is significantly more effective in treating otitis externa when compared with glacial acetic acid. This effect failed to be significant in the infected mastoid cavities group. We therefore recommend that in conjunction with aural toilet, antibiotic/steroid combination is more effective than an antibacterial agent for otitis externa. Larger numbers of infected mastoid cavities are required to be studied.

Chronic suppurative otitis media

OBJECTIVE

To review various aspects of chronic suppurative otitis media (CSOM).

DATA SOURCES

A MEDLINE search and extensive review of articles provided the information for this review.

DATA EXTRACTION

Studies describing the epidemiology, microbiology, risk factors, pathology, diagnosis, treatment, complications, and recurrence of CSOM were included.

DATA SYNTHESIS

Pseudomonas aeruginosa and anaerobes are the most predominant bacteria found in CSOM. Treatment with otic, oral, or parenteral drugs (e.g., neomycin/polymyxin B/hydrocortisone otic, ciprofloxacin, ceftazidime, or aminoglycosides) should be guided by ear fluid culture results. Prompt treatment with effective and safe antibiotics may prevent complications of CSOM.

CONCLUSIONS

Treatment of CSOM has improved as a result of availability of effective otic and oral antibiotics. Treatment of the anaerobic infection with antibiotics should be studied further.