Ear Tubes and Recurrent Ear Infection

If you're a parent of a child who is having or has had recurrent ear infections, and I can answer yes on both counts, you have no doubt heard of tubes that can be placed in your child's ears to prevent infections so those tedious bottles of suspiciously flavored antibiotic solutions can presumably be jettisoned.  As Rick and I reveal on PodMed this week, recurrent ear infections in children are a BIG problem, providing the number one condition requiring medical treatment in children under the age of five years in the United States.  So what happens when you go ahead with the devices, known as tympanostomy tubes as well as a number of other names, and your child still gets ear infections????  That's the subject of a study in the New England Journal of Medicine this week, and it provides us with some good news regarding management.

Two hundred thirty children ranging in age from 1 to 10 years, all of whom had tympanostomy tubes placed but still developed ear infections, known in the parlance as otorrhea, were enrolled in this trial.  One-third were assigned to observation only, one-third to oral amoxicillin–clavulanate suspension, and the final third to a topical solution of hydrocortisone–bacitracin–colistin eardrops.  Regimens included  hydrocortisone–bacitracin–colistin eardrops, administered as five drops, three times daily, in the discharging ear or ears for 7 days, oral amoxicillin–clavulanate suspension (30 mg of amoxicillin and 7.5 mg of clavulanate per kilogram of body weight per day, divided into three daily doses administered orally for 7 days), or observation for 2 weeks.

Parents were asked to keep a diary of medication adherence, complications or adverse events for two weeks, and any ear-related symptoms for six months.  The study physician visited the child at home (study conducted in the Netherlands)  at 2 weeks and 6 months, examined the child's ears and collected the parents' diaries and questionnaires.  The study results indicate the clear superiority of the topical treatment to both oral antibiotics and observation in providing the shortest duration of otorrhea (4 days versus 5 days versus 12 days, respectively).  At 2 weeks of follow-up, 5% of children treated with the topical solution, 44% of those who received the oral antibiotics, and 55% of those randomized to observation remained symptomatic. As Rick and I opine on PodMed, the topical treatment avoids systemic side effects of oral antibiotic treatment such as diarrhea, as well as reducing the potential for developing antibiotic-resistant organisms.  Clearly, topical treatment will also reduce parental stress resulting from dealing with a child with a symptomatic ear infection, so sounds like a win-win to us. Could such a strategy be expanded to include additional populations of children with ear infections?  That's outside the scope of this study but seems worth consideration.

Other topics this week include the use a common antidepressant to treat agitation in Alzheimer's disease in JAMA, ablation therapy for atrial fibrillation in the same journal, and how to treat arteriovenous malformations found incidentally.  Until next week, y'all live well.

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Common childhood diseases March 20, 2014 at 8:52 am

Children old enough to communicate will complain of ear ache when they have middle ear infections. Those unable or too young to talk will tug on the ear, cry, show irritability, show discomfort or refuse to eat. Yellow ear drainage, blood stained yellow ear leaks are other ways ear infection can present.

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