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Prevention and Treatment of Tympanostomy Tube Otorrhea: A Meta-analysis
Dale W Steele1,2,3,4, Gaelen P Adam5, Mengyang Di5
1Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and dale_steele@brown.edu.
Insights
Water precautions are not essential for children with ear tubes experiencing discharge. Topical antibiotic drops are more effective than oral antibiotics for treating otorrhea (ear discharge).
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Evidence Synthesis
Background:
- Children with tympanostomy tubes frequently experience ear discharge (otorrhea).
- Managing otorrhea involves considering water precautions and antibiotic treatment efficacy.
Purpose of the Study:
- To synthesize evidence on the necessity of water precautions for children with tympanostomy tubes.
- To compare the effectiveness of topical versus oral antibiotic treatments for otorrhea in this population.
Main Methods:
- Systematic literature searches were conducted across multiple databases (Medline, Cochrane, EMBASE, CINAHL).
- Study selection and data extraction were performed independently by two investigators.
- Included 25 articles, analyzing randomized controlled trials and network meta-analyses.
Main Results:
- Limited randomized evidence suggests water precautions (ear plugs, swimming avoidance) do not significantly reduce otorrhea episodes.
- Topical antibiotic-glucocorticoid drops demonstrated higher effectiveness compared to oral antibiotics (OR 5.3).
- Topical antibiotic-only drops also showed greater efficacy than oral antibiotics (OR 3.3), with topical treatments having the highest probability of being most effective.
Conclusions:
- There is a lack of compelling evidence to support the routine use of water precautions for children with tympanostomy tubes.
- Topical antibiotic preparations, particularly those with glucocorticoids, are more effective in treating otorrhea than oral antibiotics.
- Current otorrhea treatments may include off-label and potentially ototoxic medications, highlighting a need for further research.
Context:
Children with tympanostomy tubes often develop ear discharge.
Objective:
Synthesize evidence about the need for water precautions (ear plugs or swimming avoidance) and effectiveness of topical versus oral antibiotic treatment of otorrhea in children with tympanostomy tubes.
Data Sources:
Searches in Medline, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature.
Study Selection:
Abstracts and full-text articles independently screened by 2 investigators.
Data Extraction:
25 articles were included.
Results:
One randomized controlled trial (RCT) in children assigned to use ear plugs versus no precautions reported an odds ratio (OR) of 0.68 (95% confidence interval, 0.37-1.25) for >1 episode of otorrhea. Another RCT reported an OR of 0.71 (95% confidence interval, 0.29-1.76) for nonswimmers versus swimmers. Network meta-analyses suggest that, relative to oral antibiotics, topical antibiotic-glucocorticoid drops were more effective: OR 5.3 (95% credible interval, 1.2-27). The OR for antibiotic-only drops was 3.3 (95% credible interval, 0.74-16). Overall, the topical antibiotic-glucocorticoid and antibiotic-only preparations have the highest probabilities, 0.77 and 0.22 respectively, of being the most effective therapies.
Limitations:
Sparse randomized evidence (2 RCTs) and high risk of bias for nonrandomized comparative studies evaluating water precautions. Otorrhea treatments include non-US Food and Drug Administration approved, off-label, and potentially ototoxic antibiotics.
Conclusions:
No compelling evidence of a need for water precautions exists. Cure rates are higher for topical drops than oral antibiotics.
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