A new study finds that combination antibiotic/steroid eardrops work better in treating children who have infections caused by ear tubes, than oral antibiotics.
Children that have recurrent ear infections sometimes have small tubes, called tympanostomy tubes, inserted into the eardrum to help fluid drain and allow air into the middle ear. A common complication from these tubes is known as acute tympanostomy tube otorrhea. Fluid backs up into the tube and drains into the middle ear causing pressure and can be accompanied by pain and fever. This often occurs when a child has had a cold or other respiratory infection. When the middle ear becomes infected, it may fill with fluid or pus, particularly if the infection is bacterial. It can also cause a temporary loss of hearing.
Researchers, for this study, compared the eardrop treatment to oral antibiotics and the wait-and –see approach.
After two weeks, just 5 percent of children receiving the eardrops had continuing discharge from their ears. But 44 percent of those given oral antibiotics still had signs of infection, as did 55 percent of those managed with observation, according to the study.
"Children treated with eardrops had a shorter duration of the initial episode, and a lower total number of days of ear discharge, and a lower number of recurrences during six months of follow-up than children treated with oral antibiotics or initial observation," said the study's lead author, Dr. Thijs van Dongen, a physician at the Julius Center for Health Sciences and Primary Care in Utrecht, the Netherlands.
Previous studies for the best treatment of acute otorrhea have been small. This study randomly assigned 230 children between the age of 1 and 10 years old, who had ear tubes, to one of three treatments.
Seventy-six children were put into the antibiotic/steroid eardrop group, while another 77 children were assigned to receive oral antibiotics. The final 77 children were assigned to the observation group. After two weeks, the children's ears were examined again.
The researchers found that the combination eardrops worked significantly better than the other two treatments.
"Next to being the most effective in treating acute ear discharge in children with tympanostomy tubes, we also found that the increase in disease-specific health-related quality-of-life scores was largest in children treated with eardrops," said van Dongen.
Side effects were mild and no complications of middle-ear infections were reported, van Dongen added. The drops are able to deliver antibiotics directly into the infected area where the ear tube is located, avoiding the use of systemic antibiotics.
Some experts warn against the overuse of oral antibiotics as a standard treatment for infections because of the possibility that they can promote resistant bacteria, stomach irritation and diarrhea.
Van Dongen said he disagrees with doctors who advise parents to wait until ear drainage has gone on for a week before contacting their child's doctor.
"We would recommend parents to contact a physician when otorrhea occurs . . . so that children can be treated with eardrops shortly after the onset of ear discharge, and improve more quickly and have fewer recurrences in following months," said van Dongen.
The study was published in the New England Journal of Medicine.
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