What is the treatment for chronic tubotympanic suppurative otitis media (CSOM) of both ears?

From the Guidelines

Treatment for chronic tubotympanic suppurative otitis media (CSOM) of both ears should prioritize a combination of thorough ear cleaning, topical antibiotics, and potentially surgical approaches, such as tympanoplasty with cartilage reconstruction, to address both the infection and the anatomical defect. The initial treatment should focus on aural toilet (ear cleaning) performed by a healthcare professional to remove discharge and debris, followed by application of antibiotic ear drops such as ciprofloxacin 0.3% or ofloxacin 0.3%, 3-4 drops in each affected ear twice daily for 7-10 days 1. For persistent infections, oral antibiotics may be necessary, such as amoxicillin-clavulanate 875/125 mg twice daily for 10-14 days. Some key points to consider in the treatment of CSOM include:

• The use of topical antibiotics alone or with topical corticosteroids may improve symptoms compared to placebo or either treatment alone, especially in adults 1.
• Surgical intervention, such as tympanoplasty with cartilage reconstruction, may be required if there is no improvement after 2-3 weeks of medical therapy, or if there are recurrent episodes, as it promotes better graft integration rates and morphologic success compared to temporalis muscle fascia 1.
• Patients should keep their ears dry during treatment by avoiding swimming and using earplugs during bathing.
• The treatment approach should be individualized based on the severity of the disease, the presence of complications, and the patient's overall health status. It is essential to note that the treatment of CSOM should prioritize the prevention of recurrence and the restoration of hearing, and a multidisciplinary approach involving otolaryngologists, audiologists, and other healthcare professionals may be necessary to achieve optimal outcomes.

From the FDA Drug Label

The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days. Repeat, if necessary, for the opposite ear

The treatment for chronic tubotympanic suppurative otitis media of both ears with ofloxacin (OTIC) is:

• Ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into each affected ear twice daily for fourteen days 2. Note that the label specifies treatment for patients 12 years and older.

From the Research

Treatment Options for Chronic Tubotympanic Suppurative Otitis Media

• The treatment of chronic tubotympanic suppurative otitis media (CSOM) typically involves the use of antibiotics, which can be administered topically or systemically 3, 4, 5, 6.
• Topical antibiotics, such as ciprofloxacin, have been shown to be effective in achieving resolution of ear discharge in patients with CSOM 4, 5, 7.
• Systemic antibiotics, such as oral ciprofloxacin, may also be effective, but the evidence is less clear 3, 5.
• The use of topical antiseptics, such as acetic acid or boric acid, may also be effective in achieving resolution of ear discharge, but the evidence is limited 6.

Comparison of Topical and Systemic Antibiotics

• A study comparing topical ciprofloxacin with oral ciprofloxacin found that the topical administration may be more effective in achieving resolution of ear discharge 5.
• Another study found that topical ciprofloxacin drops were as effective as combined oral and topical ciprofloxacin in patients with tubotympanic CSOM 7.

Adverse Effects and Safety

• The adverse effects of antibiotics and antiseptics were poorly reported in many of the studies 3, 4, 5, 6.
• However, one study found that the addition of oral ciprofloxacin to topical ciprofloxacin did not have any beneficial effect and added only to the cost of treatment, with minimal side effects in both groups 7.

Treatment Recommendations

• Based on the available evidence, topical antibiotics, such as ciprofloxacin, may be a effective treatment option for patients with CSOM 4, 5, 7.
• The use of systemic antibiotics, such as oral ciprofloxacin, may also be considered, but the evidence is less clear 3, 5.
• Topical antiseptics, such as acetic acid or boric acid, may also be effective, but the evidence is limited 6.