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Acute otitis media in children with tympanostomy tubes

Richard V. Birtwhistle, MD CCFP FCFP
The Director of the Centre for Studies in Primary Care and a Professor in the Department of Family Medicine at Queen’s University

Andre K.W. Tan, MD FRCSC
Associate Professor and Head of the Department of Otolaryngology at Queen’s University

Correspondence to: Jason Schmelzle, Queen’s University, Department of Family Medicine, 220 Bagot St, PO Bag 8888, Kingston, ON K7L 5E9; telephone 613 533-6000, extension 73938; fax 866 599-8090; e-mailjay.schmelzle{at}queensu.ca

OBJECTIVE To review evidence regarding antibiotic treatment of acute otitis media in children with tympanostomy tubes and to discuss antibiotic resistance and ototoxicity.

QUALITY OF EVIDENCE MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for relevant articles. Articles providing level I evidence (randomized controlled trials) for treatment were used. Key words used in the search included otitis media (MeSH), middle ear ventilation (MeSH), tympanostomy tubes, and otorrhea.

MAIN MESSAGE Tympanostomy tube insertion is a common procedure; acute otitis media is a frequent sequela. Treatment options include systemic or topical antibiotics with or without corticosteroids. The development of bacterial resistance to antibiotics and ototoxicity related to treatment are important considerations. There have been well-conducted randomized controlled trials of topical versus systemic antibiotic agents. Combined with proper ear cleaning and tragal pumping, topical fluoroquinolone agents offer the most effective treatment.

CONCLUSION Current evidence suggests that a topical fluoroquinolone, with or without a corticosteroid, is the treatment of choice for acute otitis media with tympanostomy tubes.

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