What treatment is recommended for otitis externa with tympanic membrane (TM) perforation in a 14-year-old boy?

From the Guidelines

For otitis externa with tympanic membrane (TM) perforation in a 14-year-old boy, I recommend using non-ototoxic topical antibiotic drops such as ciprofloxacin 0.3% (Ciprodex) or ofloxacin 0.3% (Floxin Otic), 3-4 drops in the affected ear twice daily for 7-10 days, as supported by the most recent and highest quality study 1. These fluoroquinolone drops are safe with TM perforation as they don't cause ototoxicity. Avoid aminoglycoside-containing drops (like neomycin or gentamicin) and alcohol-based preparations as these can damage the inner ear if they pass through the perforation. Some key points to consider in the management of otitis externa with TM perforation include:

• Keeping the ear dry during treatment by using a cotton ball lightly coated with petroleum jelly during showers or baths.
• Gentle cleaning of the external ear canal may be necessary before drop application, but should be done carefully to avoid further trauma.
• Pain management with acetaminophen or ibuprofen can be used as needed.
• The patient should be re-evaluated after treatment completion to ensure resolution of the infection and to assess TM healing.
• Most perforations will heal spontaneously, but persistent perforations may require ENT referral, as noted in previous guidelines 1. It's also important to note that the choice of eardrop may depend on various factors, including cost, dosing frequency, and the doctor's experience, as well as the patient's medical history and current condition, as discussed in the guidelines 1. Overall, the goal of treatment is to resolve the infection, promote healing of the TM, and prevent complications, while also considering the potential risks and benefits of different treatment options, as emphasized in the most recent study 1.

From the FDA Drug Label

The recommended dosage regimen for the treatment of otitis externa is: For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days. Chronic Suppurative Otitis Media with perforated tympanic membranes 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.

For a 14-year-old boy with otitis externa and a tympanic membrane (TM) perforation, the recommended treatment is ofloxacin (OTIC).

• The patient is older than 13, so the recommended dosage is ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear.
• However, since the patient has a TM perforation, the dosage regimen for Chronic Suppurative Otitis Media with perforated tympanic membranes should be considered, which is ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 2.

From the Research

Treatment Options for Otitis Externa with TM Perforation

• For a 14-year-old boy with otitis externa and a perforated tympanic membrane, ofloxacin otic solution 0.3% can be considered as a treatment option 3.
• This solution has been shown to be effective in treating otitis externa in children, with a clinical cure rate of over 95% 3.
• Additionally, ofloxacin otic solution 0.3% is also effective in treating chronic suppurative otitis media in adolescents and adults with perforated tympanic membranes, with a clinical cure rate of 75 to 91% 3.

Safety and Tolerability

• Ofloxacin otic solution 0.3% is well tolerated, with limited systemic absorption and a low incidence of adverse events, including bitter taste and pruritus 3.
• The solution is not associated with ototoxicity, making it a safe option for patients with perforated tympanic membranes 3.

Comparison with Other Treatments

• Ofloxacin otic solution 0.3% has been compared to other treatments, including gelatin sponge patching, and has been shown to be an effective treatment option for large traumatic tympanic membrane perforations 4.
• However, it is essential to note that ofloxacin otic solution 0.3% must be self-applied daily to keep the perforation edge moist, while gelatin sponge patching requires periodic removal and re-patching 4.

Irrelevant Studies

• A study on steroid-binding proteins in carcinoma of the human male breast is not relevant to the treatment of otitis externa with TM perforation 5.