What is the treatment for ear discharge from tympanostomy tubes in adults?

Treatment for Ear Discharge from Tympanostomy Tubes in Adults

Topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) are the first-line treatment for ear discharge from tympanostomy tubes in adults, administered twice daily for up to 10 days. 1

First-Line Treatment Approach

• Topical antibiotic therapy is significantly more effective than systemic antibiotics, with clinical cure rates of 77-96% compared to only 30-67% with oral antibiotics 2, 1
• Topical therapy provides higher drug concentration at the infection site and better coverage of likely pathogens, particularly Pseudomonas aeruginosa 1, 3
• Common pathogens in ear tube discharge include Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, and other respiratory pathogens 1, 3

Proper Administration Technique

• Clean the ear canal of debris or discharge before administering drops using:
  • Cotton-tipped swab with hydrogen peroxide or warm water 2, 1
  • Cotton ball to absorb drainage 2
  • Gentle suction if available 2, 1
• After instilling drops, "pump" the tragus (flap of skin in front of ear canal) several times to help the drops enter the ear tube 2, 1
• For plugged tubes, vinegar solution may be more effective than water or antibiotic drops for dissolving dried secretions 4

Additional Management Measures

• Prevent water entry into the ear canal during treatment by:
  • Using cotton saturated with Vaseline to cover the opening during bathing or hair washing 2
  • Avoiding swimming until the drainage stops 2
• Limit topical therapy to a single course of no more than 10 days to avoid fungal (yeast) infections of the ear canal 2, 1
• For persistent discharge, consider middle ear irrigation to remove thick effusions that may be localized in hard-to-reach areas 5

When to Consider Systemic Antibiotics

• Systemic antibiotics may be appropriate in specific situations:
  • Cellulitis of the pinna or adjacent skin 1
  • Concurrent bacterial infection elsewhere 1
  • Signs of severe infection or systemic illness 1
  • Persistent or worsening discharge despite topical antibiotic therapy 2, 1
  • Immunocompromised patients or those with diabetes 2

Important Considerations and Cautions

• Only use topical drops approved for use with tympanostomy tubes (quinolone drops with or without steroid) 1
• Avoid aminoglycoside-containing eardrops due to potential ototoxicity in the presence of a non-intact tympanic membrane 1, 6
• Patients with diabetes, immunocompromised states, or history of radiotherapy require special consideration as they are more susceptible to otomycosis and necrotizing otitis externa 2
• MRSA should be suspected in recurrent or recalcitrant cases 1

Follow-up Recommendations

• If discharge continues for more than 7 days despite treatment, follow-up with an otolaryngologist is recommended 2, 1
• Routine follow-up every 4-6 months is important to ensure tubes are functioning properly 2
• Consider tube removal if otorrhea becomes chronic and unresponsive to treatment 7

Advantages of Topical Therapy

• Topical therapy avoids adverse events associated with systemic antibiotics (dermatitis, allergic reactions, GI upset, oral thrush) 1
• Reduces potential for increased antibiotic resistance compared to systemic antibiotics 1
• Ofloxacin has activity against a wide range of gram-negative and gram-positive microorganisms commonly found in ear infections 3