What ear drops are recommended for an ear infection with a tympanostomy (tympanostomy tube)?

Ear Drops for Ear Infections with Tympanostomy Tubes

Topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) are the first-line treatment for ear infections with tympanostomy tubes, not oral antibiotics. 1

First-Line Treatment Options

Recommended Ear Drops:

• Ofloxacin 0.3% otic solution:

  • For children 1-12 years: Five drops (0.25 mL) twice daily for 10 days 2
  • For patients 13 years and older: Ten drops (0.5 mL) twice daily for 14 days 2

• Ciprofloxacin-dexamethasone otic suspension:

  • Four drops twice daily for 7 days 3
  • Shown to be superior to ofloxacin with higher clinical cure rates (90% vs 78%) and shorter median time to cessation of otorrhea (4 days vs 6 days) 3

Proper Administration Technique

1. Warm the solution by holding the bottle in hand for 1-2 minutes to prevent dizziness 2
2. Position patient with affected ear upward 2
3. Instill prescribed number of drops into ear canal 2
4. Critical step: Pump the tragus (flap of skin in front of ear canal) 4 times by pushing inward to facilitate penetration of drops into the middle ear 1, 2, 4
   • Without tragal pumping, drops often fail to reach the middle ear 4
5. Maintain position for 5 minutes 2
6. Repeat for opposite ear if needed 2

Managing Ear Drainage

1. Clean ear canal before administering drops:
   • Remove drainage with cotton-tipped swab dipped in hydrogen peroxide or warm water 1
   • Use cotton ball to absorb drainage 1
   • Gently suction with infant nasal aspirator if needed 1
2. Persistent debris may require professional removal through suctioning 1

Important Considerations

• Topical therapy achieves significantly higher clinical cure rates (77-96%) compared to systemic antibiotics (30-67%) 1
• Only use drops specifically approved for tympanostomy tubes (ofloxacin or ciprofloxacin-dexamethasone) to avoid potential ototoxicity from aminoglycoside-containing drops 1, 5
• Limit topical therapy to a single course of no more than 10 days to prevent fungal external otitis 1
• Prevent water entry into ear canal during treatment by covering the opening with cotton saturated with petroleum jelly during bathing or hair washing 1, 5
• Avoid swimming until drainage stops 1

When to Consider Oral Antibiotics

Systemic antibiotics should only be used when:

• Cellulitis of the pinna or adjacent skin is present 1
• Concurrent bacterial infection exists (e.g., sinusitis, pneumonia) 1
• Signs of severe infection are present (high fever, severe otalgia, toxic appearance) 1
• Ear infection persists or worsens despite topical therapy 1
• Child cannot tolerate ear drops 1
• Patient is immunocompromised 1

When to Seek Further Care

Contact an otolaryngologist if:

• Drainage continues for more than 7 days 1
• Drainage from ears occurs frequently 1
• Excessive wax builds up in ear canal 1
• Hearing loss or continued ear pain/discomfort occurs 1

Topical antibiotic ear drops are highly effective, achieve better bacterial eradication, and have fewer side effects than oral antibiotics for treating ear infections with tympanostomy tubes.