From the Guidelines
For individuals with ear tubes, antibiotic ear drops containing fluoroquinolones (such as ciprofloxacin or ofloxacin) are typically recommended for treating infections or drainage. The most recent and highest quality study, 1, supports the use of topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. Common options include Ciprodex (ciprofloxacin 0.3% with dexamethasone 0.1%), Cipro HC (ciprofloxacin 0.2% with hydrocortisone 1%), or Floxin Otic (ofloxacin 0.3%).
Key Points to Consider
- The standard dosage is typically 4 drops in the affected ear twice daily for 7-10 days.
- When administering drops, tilt the head to the side with the affected ear facing up, pull the earlobe gently to straighten the ear canal, and place the drops.
- Maintain this position for 1-2 minutes to allow the medication to flow through the tube into the middle ear.
- These fluoroquinolone drops are preferred because they're effective against common ear pathogens and are non-ototoxic, meaning they don't damage hearing structures.
- Unlike some other antibiotic drops that may be harmful if they reach the middle ear, these medications are specifically approved for use with ear tubes.
Administration and Precautions
- Before administering drops, clean any discharge or pus that is blocking the ear canal opening using a tissue spear, as described in 1.
- For routine water protection during swimming or bathing, specialized ear plugs or a petroleum jelly-coated cotton ball may be used, though many physicians now advise that routine water protection isn't necessary for most children with tubes, as noted in 1 and 1.
Follow-Up Care
- Regular follow-ups with an ear, nose, and throat provider are recommended to check the ear tubes, even if the individual has no problems or concerns, as emphasized in 1.
From the FDA Drug Label
The recommended dosage regimen for the treatment of acute otitis media in pediatric patients (from 1 to 12 years old) with tympanostomy tubes is: Five drops (0.25 mL, 0. 75 mg ofloxacin) instilled into the affected ear twice daily for ten days. The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness that may result from the instillation of a cold solution. The patient should lie with the affected ear upward, and then the drops should be instilled The tragus should then be pumped 4 times by pushing inward to facilitate penetration of the drops into the middle ear.
Ofloxacin (OTIC) ear drops are safe to use with ear tubes, specifically for the treatment of acute otitis media in pediatric patients with tympanostomy tubes 2. The recommended dosage is five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear twice daily for ten days.
From the Research
Ear Drops Safe to Use with Ear Tubes
- Ciprofloxacin otic solution is safe and effective in treating otorrhea in children with ear tubes, as shown in studies 3, 4, 5, 6.
- The combination of ciprofloxacin and fluocinolone acetonide is more effective than ciprofloxacin alone in treating acute otitis media with tympanostomy tubes 3.
- Oxymetazoline is equivalent to ciprofloxacin in preventing postoperative otorrhea or tympanostomy tube obstruction 7.
- Normal saline can be used as an alternative to ciprofloxacin in ears without an active ear infection at the time of tube placement, reducing cost and unnecessary antibiotic use 4.
Key Findings
- Ciprofloxacin otic solution has been shown to be safe and well-tolerated in children with ear tubes, with minimal adverse events reported 3, 5, 6.
- The use of ciprofloxacin otic solution can reduce the incidence and duration of otorrhea in children with ear tubes 3, 5.
- Oxymetazoline and ciprofloxacin solutions are equivalent in preventing postoperative otorrhea and tube occlusion after tympanostomy tube placement 7.