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Fam Pract 2022 Jan 12. Epub 2022 Jan 12.

Department of Otolaryngology, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK.

Introduction: Referrals for otitis externa (OE) have dramatically increased but the reasons for this remain unclear. We aim to characterize management of patients both pre- and post-referral to identify areas of improvement at the primary-secondary care interface.

Methods: Questionnaire study from consultant-led research clinic specifically set up to prospectively analyse OE referrals at a tertiary referral centre for Otolaryngology. Read More

J Laryngol Otol 2022 Jun 25;136(6):486-491. Epub 2021 Nov 25.

Department of Otolaryngology, Population Health Sciences Institute, Newcastle University, UK.

Objective: Otitis externa accounts for 1.1-1.3 per cent of patient presentations in primary care and 25 per cent of urgent referrals to ENT. Read More

Mycopathologia 2021 Dec 19;186(6):871-876. Epub 2021 Aug 19.

Laboratory of Medical Mycology and Space Environmental Medicine, School of Medicine, Graduate School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.

The prevalence of fungal otitis externa, or otomycosis, has been increasing in recent decades. Fungi may act as primary pathogens in this condition, or they may occur as secondary infections after prolonged ototopical treatment with antibiotics, which alters the flora of the external auditory canal (EAC) and enables overgrowth of its fungal inhabitants. We report here a case of otomycosis by Candida parapsilosis, Malassezia obtusa, and Malassezia furfur as a secondary infection following prolonged otic ofloxacin treatment. Read More

Am J Otolaryngol 2021 Sep-Oct;42(5):103130. Epub 2021 Jun 19.

Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, USA. Electronic address:

Purpose: To examine how patients self-administer ear drops, ascertain their perceived difficulty in performing the task and determine if they are able to deliver the correct dosage.

Materials And Methods: This is a prospective cohort study performed in an otology outpatient clinic with twenty-one subjects with a condition requiring ototopical antibiotics. The number of ear drops applied as well as skills performed during ear drop application was measured. Read More

Otol Neurotol 2021 08;42(7):e887-e893

Dartmouth-Hitchcock Medical Center, Lebanon.

Hypothesis: Ciprofloxacin-resistant pathogens are inhibited by high concentrations of ciprofloxacin found in commercially-available ototopical solutions.

Background: Ciprofloxacin-resistant pathogens in otitis media are currently treated with ototopical ciprofloxacin suspensions. This is done irrespective of laboratory-reported ciprofloxacin susceptibility, under the assumption that the high concentration of ciprofloxacin applied topically is sufficient to overcome antimicrobial resistance. Read More

PLoS One 2020 12;15(10):e0240535. Epub 2020 Oct 12.

Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.

Acute otitis media (AOM) is the main indication for pediatric antibiotic prescriptions, accounting for 25% of prescriptions. While the use of topical drops can minimize the administered dose of antibiotic and adverse systemic effects compared to oral antibiotics, their use has limitations, partially due to low patient compliance, high dosing frequency, and difficulty of administration. Lack of proper treatment can lead to development of chronic OM, which may require invasive interventions. Read More

Otol Neurotol 2020 12;41(10):1438-1446

Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Objective: Temporal bone osteoradionecrosis (TBORN) is a rare, chronic complication of head and neck radiation. Initial treatment consists of conservative management, with surgical resection of necrotic bone indicated for cases of severe, symptomatic, or progressive disease. Pentoxifylline-tocopherol (PENTO) has demonstrated usefulness for osteoradionecrosis of other head and neck subsites. Read More

PLoS One 2020 14;15(4):e0231573. Epub 2020 Apr 14.

Department of Ear Nose and Throat, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.

Objective: Chronic suppurative otitis media (CSOM) is a chronic infectious disease with worldwide prevalence that causes hearing loss and decreased quality of life. As current (antibiotic) treatments often unsuccessful and antibiotic resistance is emerging, alternative agents and/or strategies are urgently needed. We considered the synthetic antimicrobial and anti-biofilm peptide P60. Read More

Ear Nose Throat J 2020 Nov 19;99(1_suppl):35S-38S. Epub 2020 Mar 19.

142902Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA.

Objectives: To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea.

Methods: The Medical Literature Analysis and Retrieval System Online was searched via PubMed for relevant articles using serous mastoiditis, mastoidectomy, chronic otorrhea, tube otorrhea, tympanostomy tubes, and biofilm as keywords.

Results: Further understanding of the pathophysiology of otorrhea and the development of ototopical fluoroquinolones have made a draining tympanostomy tube more manageable. Read More

Adv Otorhinolaryngol 2019 15;82:101-110. Epub 2019 Jan 15.

Many pharmaceuticals have ototoxicity (both cochlear and/or vestibular) as part of their adverse medication profile. The aminoglycoside class of antimicrobials has been especially well studied in this regard. Many questions remain unanswered as to how to best monitor and prevent this complication. Read More

Int J Pharm 2019 Mar 23;559:201-209. Epub 2019 Jan 23.

Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt. Electronic address:

Acute otitis media (AOM), an infection in the middle ear, is usually treated through systemic administration of antibiotics because the stratum corneum of the intact tympanic-membrane (TM) possesses low permeability that holds against the ototopical antibiotics use. Therefore, the objective of this work was to encapsulate levofloxacin (LFX) into polyethylene glycol 400 (PEG 400) decorated nanoliposomes (PNLs) as an approach for drug delivery through the intact tympanic-membrane. LFX loaded-PNLs were primed by ethanol injection technique. Read More

J Int Adv Otol 2019 Apr;15(1):22-27

Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.

Objectives: Topical treatment is first choice in the treatment of uncomplicated chronic otitis media. It was intended to assess auditory and histopathological safety of ototopical use of mercurochrome solution in rats with induced tympanic membrane perforation.

Materials And Methods: The study was conducted on 21 female Wistar-Albino rats which were randomly assigned into 3 groups. Read More

Int J Pediatr Otorhinolaryngol 2018 Jul 16;110:110-113. Epub 2018 May 16.

University of Texas Health San Antonio, Department of Otolaryngology - Head and Neck Surgery, United States. Electronic address:

Objectives/introduction: Tympanostomy tube placement is the most common surgical procedure in the pediatric population with important financial implications to our healthcare institutions. The purpose of this study is to apply various cost models in different clinical environments to determine the most cost effective way to prescribe ear drops after tympanostomy tube insertion.

Methods: Two distinct practice models were designed: a Uniform Treatment Model and a Disease Specific Model. Read More

Can Commun Dis Rep 2017 Jul 6;43(7-8):150-153. Epub 2017 Jul 6.

Section of Infectious Diseases, Departments of Internal Medicine and Medical Microbiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.

is a fungal pathogen that has recently emerged as a global threat to public health. It was first described in Japan in 2009 and has since been reported in 17 countries on five continents. This case report describes the first reported case of multidrug-resistant in Canada. Read More

Int J Pediatr Otorhinolaryngol 2018 Jun 24;109:36-39. Epub 2018 Mar 24.

Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, USA; Department of Pediatrics, Lewis Katz School of Medicine at Temple University, USA. Electronic address:

Objective: To demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA).

Methods: We treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/- ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared. Read More

Otolaryngol Head Neck Surg 2018 05 13;158(5):923-929. Epub 2018 Mar 13.

1 Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.

Objective Despite the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) otologic infections, choice of treatment remains controversial. Only fluoroquinolone-containing ototopical preparations are approved by the US Food and Drug Administration for middle ear application. Furthermore, American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines advocate ototopical monotherapy for both tympanostomy tube otorrhea and acute otitis externa. Read More

Otolaryngol Head Neck Surg 2018 05 20;158(5):917-922. Epub 2018 Feb 20.

1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Florida, Gainesville, Florida, USA.

Objective Ciprofloxacin + dexamethasone ear drops have been associated with higher rates of tympanic membrane perforations than ofloxacin. This was thought to be an effect of the steroid; however, ciprofloxacin (sans steroid) has been found to be more toxic to tympanic membrane fibroblasts than ofloxacin in vitro. This study aimed to compare the effect of these agents on tympanic membrane healing in vivo. Read More

Braz J Otorhinolaryngol 2018 Jul - Aug;84(4):441-447. Epub 2017 May 31.

Chonnam National University Medical School, Department of Otolaryngology, Gwangju, South Korea. Electronic address:

Introduction: Methicillin-resistant staphylococcus aureus is an emerging problem for the treatment of chronic suppurative otitis media, and also for pediatric tympanostomy tube otorrhea. To date, there are no effective topical antibiotic drugs to treat methicillin-resistant staphylococcus aureus otorrhea.

Objective: In this study, we evaluated the ototoxicity of topical KR-12-a2 solution on the cochlea when it is applied topically in the middle ear of guinea pigs. Read More

Int J Pharm 2017 Apr 7;522(1-2):157-164. Epub 2017 Mar 7.

Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Egypt.

The aim of this research was to encapsulate ciprofloxacin, a broad spectrum fluoroquinolone antibiotic, into Span 60 based nano-elastic vesicles, nano-spanlastics, for accomplishing improved non invasive trans-tympanic delivery, providing means for ototopical treatment of acute otitis media (AOM). To achieve this purpose, ciprofloxacin-loaded nano-spanlastics were prepared by thin film hydration (TFH) technique, using several non-ionic edge activators (EAs) according to full factorial design (3). The investigation of the effect of formulation variables on nano-spanlastic characteristics and selection of the optimum formula were performed using Design-Expert software. Read More

J Int Adv Otol 2017 Apr 7;13(1):105-109. Epub 2016 Nov 7.

Department of Otorhinolaryngology, Erciyes University School of Medicine, Kayseri, Turkey.

Objective: In patients with a perforated tympanic membrane, topically administered medication reaches the middle ear and thus creates a risk of ototoxicity. The aim of the present study was to evaluate the possible ototoxic effect of the antifungal medication nystatin when administered to the rat middle ear cavity.

Materials And Methods: Three groups (negative control, positive control, and study groups), each containing eight rats, were formed. Read More

Otolaryngol Head Neck Surg 2017 02 3;156(2):341-349. Epub 2016 Oct 3.

1 Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA.

Objective To assess collagen and α-tubulin levels of mouse tympanic membrane fibroblasts treated with quinolone and aminoglycoside antibiotics at concentrations found in eardrops. Study Design Prospective controlled cell culture study. Setting Academic tertiary medical center. Read More

Otol Neurotol 2016 09;37(8):1049-54

Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Objectives: To forecast national Medicaid prescription volumes for common ototopical antibiotics, and correlate prescription volumes with internet user search interest using Google Trends (GT).

Study Design: National United States Medicaid prescription and GT user search database analysis.

Methods: Quarterly national Medicaid summary drug utilization data and weekly GT search engine data for ciprofloxacin-dexamethasone (CD), ofloxacin (OF), and Cortisporin (CS) ototopicals were obtained from January 2008 to July 2014. Read More

J Laryngol Otol 2016 Jan 20;130(1):2-7. Epub 2015 Nov 20.

Department of Otorhinolaryngology,Betsi Cadwaladr University Health Board,Rhyl,Wales,UK.

Objective: This systematic review aimed to establish that quinolones are as effective as aminoglycosides when used to treat chronic suppurative otitis media.

Method: The review included good quality, randomised, controlled trials on human subjects, published in English, that compared topical aminoglycosides with topical quinolones for the treatment of chronic suppurative otitis media.

Results: Nine trials met the criteria. Read More

Am J Otolaryngol 2015 Nov-Dec;36(6):814-9. Epub 2015 Jul 7.

Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC.

Objective: To determine if providers prescribe more affordable topical antibacterial therapy for patients who are economically disadvantaged or come from economically disadvantaged communities.

Study Design: Prescription drug database review.

Setting: Large academic hospital network. Read More

Pediatr Infect Dis J 2015 Apr;34(4):355-60

From the *Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; †Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands; ‡Virology Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; §Department of Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; and ¶ENT Clinical Trials Programme, Ear Institute, University College London, London, United Kingdom.

Background: Acute tympanostomy-tube otorrhea is a common sequela in children with tympanostomy tubes. Acute tympanostomy-tube otorrhea is generally a symptom of an acute middle ear infection, whereby middle ear fluid drains through the tube. The widespread use of pneumococcal conjugate vaccination (PCV) has changed the bacterial prevalence in the upper respiratory tract of children, but its impact on bacterial and viral pathogens causing acute tympanostomy-tube otorrhea is yet unknown. Read More

JAMA Otolaryngol Head Neck Surg 2015 Feb;141(2):148-53

Department of Otolaryngology, University of Florida College of Medicine, Gainesville.

Importance: Tympanostomy tube (TT) biofilm formation may lead to sequelae.

Objective: To determine whether the acute pathogen Haemophilus influenzae promotes TT attachment and biofilm formation by the chronic pathogen Staphylococcus aureus.

Design And Setting: Controlled, in vitro microbiological study at an academic research laboratory using TTs treated with 0 (untreated), 10, or 3000 µg/mL ciprofloxacin or ethylene oxide and TTs with and without prior H influenzae exposure. Read More

Int J Pharm 2014 Sep 24;472(1-2):304-14. Epub 2014 Jun 24.

Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo 11562, Egypt.

Ciprofloxacin is a synthetic fluoroquinolone antibiotic that has been used for systemic treatment of otitis media in adults. It was approved for topical treatment of otorrhea in children with tympanostomy tubes. The aim of this work was to enhance the local non-invasive delivery of ciprofloxacin to the middle ear across an intact tympanic membrane (TM) in an attempt to treat acute otitis media (AOM) ototopically. Read More

J Laryngol Otol 2013 Nov 29;127(11):1143-4. Epub 2013 Oct 29.

Department of Otology and Laryngology, Medical University of Vienna, Austria.

Introduction: The exact aetiology of congenital cholesteatoma, the less common form of this destructive disease, is still under debate.

Case Report: A two-year-old boy was referred to paediatric otolaryngology with persistent, bloody, left-sided otorrhoea refractory to oral and ototopical antibiotics. Prior to its onset at age 16 months, all ear examinations on the affected side were normal. Read More

Expert Opin Pharmacother 2013 Dec 7;14(17):2399-405. Epub 2013 Oct 7.

University of Texas Southwestern Medical Center, Department of Otolaryngology , 5323 Harry Hines Blvd, Dallas, TX 75390 , USA

Introduction: Ciprofloxacin 0.3% with dexamethasone 0.1% (ciprofloxacin/dexamethasone) is an ototopical preparation for acute otitis externa, otorrhea with tympanostomy tubes, and is frequently used to treat chronic suppurative otitis media (CSOM). Read More

Pediatr Emerg Care 2013 Feb;29(2):203-8

Inova Fairfax Hospital for Children, Pediatric Residency Program, Falls Church, VA 22042-3300, USA.

Introduction: Posttympanostomy tube otorrhea also known as acute otitis media with tympanostomy tubes (AOMT) occurs in 15% to 80% of children with tympanostomy tubes. Its management is fairly standardized among pediatric ear, nose, and throat (ENT) physicians owing to recommendations published by the American Academy of Otolaryngology-Head and Neck Surgery. Pediatric emergency medicine (EM) physicians have no such guidelines. Read More