gramicidin-a and Otitis-Media--Suppurative

Chronic suppurative otitis media (CSOM) affects many children in disadvantaged populations. The most appropriate topical antibiotic treatment in children with persistent disease is unclear.. Children with CSOM despite standard topical treatment were randomized to 6-8 weeks of topical ciprofloxacin (CIP) versus topical framycetin-gramicidin-dexamethasone (FGD). Otoscopic, audiologic, and microbiologic outcomes were measured using standardized assessments and blinding.. Ninety-seven children were randomized. Ear discharge failed to resolve at the end of therapy in 70% children regardless of allocation [risk difference = -2%; (95% CI: -20 to 16)]. Healing of the tympanic membrane occurred in one of 50 children in the CIP group and none of 47 children in the FGD group. Severity of discharge failed to improve in more than 50% children in each group, and mean hearing threshold (38 dB and 35 dB) and proportion of children with greater than 25 dB hearing loss (98% and 88%) were not significantly different between the CIP and FGD groups. Side effects were rare.. This study showed a similarly low rate of improvement or cure in children with persistent CSOM for both CIP and FGD topical therapies. Complications and side effects were insufficient to cease therapy or inform prescribing of either therapy.

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Australia; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Dexamethasone; Drug Therapy, Combination; Female; Framycetin; Gramicidin; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Otitis Media, Suppurative; Treatment Outcome

To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children.. Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM.. Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10-21 days after starting treatment.. 111 children aged 1-14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%-33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%).. Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.

Topics: Administration, Topical; Adolescent; Anti-Infective Agents; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Community Health Services; Dexamethasone; Drug Administration Schedule; Female; Framycetin; Gramicidin; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Otitis Media, Suppurative; Povidone-Iodine; Queensland; Treatment Outcome; Western Australia

Otitis externa and chronic otitis media often present to the otolaryngologist with a discharging ear. The conventional method of treatment is to perform regular aural toilet and insert medicated dressings into the external auditory canal. This treatment is either performed by trained nurses or medical staff, but in either case is time consuming. This study compares the efficacy of the above standard regimen with a novel treatment where a single aural toilet is carried out and medicated ointment instilled into the ear. Both regimens were evaluated at three weeks. Our results shows that there was no significant difference between the two treatment regimens with regard to the resolution of either of the conditions studied or the improvement in the symptom status of the patients. On the basis of this it would seem that a single aural toilet and instillation of medicated ointment is a valid treatment option, cuts down hospital attendance and could be performed in the community by general medical practitioners or trained practice nurses.

Topics: Administration, Topical; Chronic Disease; Drug Administration Schedule; Drug Combinations; Gramicidin; Humans; Neomycin; Nystatin; Ointments; Otitis; Otitis Externa; Otitis Media, Suppurative; Triamcinolone Acetonide

Children with tympanostomy tubes have always been considered somewhat handicapped in regard to swimming and bathing. Their parents had to maintain constant surveillance to prevent then from getting water in their ears. A prospective study involving more than 1,000 children was conducted between June 1981 and August 1982 on two groups of randomly selected patients to determine the prevalence of suppurative otitis media and its relationship to bathing and swimming. One group had to follow strict rules to prevent water entering the ear (bathing caps, earplugs) whereas the other group was allowed to bathe and swim without any precaution upon the condition of using a polymyxin B/gramicidin ear drop combination at bedtime on the day they swam. The study shows no increase in prevalence of suppurative otitis media in the "open canal" group as compared to the "closed canal" group. Furthermore, the monthly distribution of infections shows a relatively evan distribution throughout the year. This study implies that swimming and bathing are safe for the vast majority of children with tympanostomy tubes and thus simplifies enormously the post-myringotomy care for the child, the parents, and the physician.

Topics: Baths; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Female; Follow-Up Studies; Gramicidin; Humans; Infant; Infant, Newborn; Male; Middle Ear Ventilation; Otitis Media, Suppurative; Polymyxin B; Postoperative Care; Random Allocation; Risk; Swimming; Tympanic Membrane

Patients receiving Gentisone HC, Sofradex and Otomize for chronic suppurative otitis media and otitis externa were investigated for compliance of medication. Drops were accurately weighed before and after use so that both the amount used and the expected amount patients should have used could be calculated. The amount used differed statistically from the amount expected for Sofradex (P = 0.0008) but not for Gentisone HC (P = 0.1049) or Otomize (P = 0.7553) when analysed by a Mann-Whitney U-test. There was a trend to overdose with both Sofradex & Gentisone HC. The reason for the differences, we believe, is due to a combination of both differing delivery systems and drop viscosities. Manufacturers need to improve delivery systems so that patients can deliver a reproducible volume of medication each time with ease.

Topics: Administration, Topical; Chronic Disease; Dexamethasone; Drug Combinations; Framycetin; Gentamicins; Gramicidin; Humans; Hydrocortisone; Neomycin; Otitis Externa; Otitis Media, Suppurative; Patient Compliance; Statistics, Nonparametric

We report the case of a 10-year-old boy with prolonged fever who was found to have tularemia of the middle ear. Otolaryngologic cases including oropharyngeal and glandular or ulceroglandular forms of the head and neck region are estimated to account for 12% of all tularemia cases, but to date we have not seen a report of tularemia in the middle ear. The possibility of tularemia may not occur to a physician because of the wide variation of clinical manifestations.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Antigens, Bacterial; Child; Ciprofloxacin; Dexamethasone; Drug Combinations; Framycetin; Francisella tularensis; Gramicidin; Humans; Male; Otitis Media, Suppurative; Tularemia

To compare advice given by specialist otolaryngologists to patients following ventilation tube insertion and the management of purulent otorrhoea in these patients.. A postal questionnaire was sent to all 59 specialists currently listed in the New Zealand Otolaryngology Specialist Register.. 96.5% of specialist otolaryngologists replied, 88% in sufficient detail for analysis in this study. The vast majority (96%) allowed patients to swim with tubes in situ, and all allowed hair washing. Advice for ear protection varied. If otorrhoea develops with ventilation tubes in situ, 90% of specialists advise patients to stop swimming, but allow hair washing to continue with ear protection. Ninety percent of specialists' initial treatment of otorrhoea involves a combination of suction toilet and topical steroid/antibiotic drops.. In general, specialist otolaryngologists in New Zealand give similar advice to patients with ventilation tubes. However, the specific methods of ear protection advised when swimming and hair washing varies markedly.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Inflammatory Agents; Attitude of Health Personnel; Betamethasone; Clavulanic Acids; Dexamethasone; Drug Combinations; Drug Therapy, Combination; Ear Protective Devices; Framycetin; Gramicidin; Hair Preparations; Humans; Middle Ear Ventilation; Neomycin; New Zealand; Otitis Media, Suppurative; Otolaryngology; Recurrence; Swimming