sodium-bicarbonate and Otitis-Media-with-Effusion

This randomised prospective trial compared the efficacy of sodium bicarbonate and hydrogen peroxide ear drops in clearing a blocked tympanostomy tube. Tympanostomy tubes, 110 in number, obstructed with blood or inspissated secretions were randomised into treatment and control groups. Details of the operative procedure were retrospectively collected from the patients notes. The patients were reviewed after 2 weeks for both clinical and tympanometric evidence of clearance of the tube and evidence of complications of the drops. There was no significant therapeutic advantage between the two drops (P > 0.9), but in both treatment arms there was a significant therapeutic advantage over a period of observation (P < 0.05 in both groups). Otorrhoea and pain on instilling the drops occurred with equal incidence in both treatment groups. As obstruction of tympanostomy tubes is a common occurrence which often prompts surgical reventilation, there is great potential for cost savings if conservative treatment can be used effectively. The treatments for obstructed tympanostomy tubes are reviewed and methods of prevention of this common occurrence are discussed.

Topics: Acoustic Impedance Tests; Administration, Topical; Adolescent; Adult; Child; Child, Preschool; Ear Canal; Equipment Failure; Female; Follow-Up Studies; Foreign-Body Migration; Humans; Hydrogen Peroxide; Infant; Male; Middle Aged; Middle Ear Ventilation; Otitis Media with Effusion; Prospective Studies; Retrospective Studies; Sodium Bicarbonate; Tympanic Membrane

To compare the efficacy of 5% NaHCO3, 3% H2O2, Sofradex (dexamethasone sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%), 0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with harvested thick middle ear effusion fluid.. A blinded in-vitro study.. District general hospital.. A total of 473 grommets were blocked with freshly harvested unpooled thick middle ear effusion fluid obtained from 68 patients.. Patency of the grommets before and 7 days after intervention was ascertained by tympanometry and close visual inspection.. Instillation of eardrops leads to a statistically significant increase in the clearance of grommets as compared with not using any drops (chi2 = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8 for NaHCO3, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and 9.5 for H2O2 eardrops. Pair-wise comparison was only significant for comparison between 5% NaHCO3 and 3% H2O2 eardrops (Bonferroni corrected P = 0.01, odds ratio = 4.3, CI = 1.9-9.9).. Use of eardrops leads to a clinically and statistically significant increase in the clearance of blocked grommets. Of the five drops used, 5% NaHCO3 was the most efficacious and 3% H2O2 the least efficacious. Limitations of this in-vitro study are recognized and a prospective in-vivo double blind randomized controlled trial is planned.

Topics: Acetic Acid; Acoustic Impedance Tests; Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Child; Child, Preschool; Dexamethasone; Drug Combinations; Female; Framycetin; Gramicidin; Humans; In Vitro Techniques; Infant; Male; Middle Aged; Middle Ear Ventilation; Otitis Media with Effusion; Pharmaceutical Solutions; Sodium Bicarbonate; Sodium Chloride