Chronic Suppurative Otitis Media Medication

  • Author: David Parry, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Oct 13, 2011
 

Medication Summary

An expert panel of the American Academy of Otolaryngology-Head and Neck Surgery has provide guidelines for the use of antibiotics in chronic suppurative otitis media (CSOM).[19] The panel concluded that topical antibiotics alone constitute first-line treatment for most patients, barring systemic infection. If systemic infection is present, oral or, if necessary, parenteral antibiotics are warranted.

Although studies suggest only a slight risk of sensorineural hearing loss in humans from short courses of topical aminoglycosides, the risk of vestibular toxicity appears to be much higher.

The introduction of fluoroquinolones, which have no potential for ototoxicity, relegates aminoglycosides to a secondary treatment alternative in most areas. Patients who receive aminoglycoside drops when fluoroquinolone drops are available and subsequently develop sensorineural hearing loss or balance disturbance may blame their physician.

Next

Antibiotics/Corticosteroids, Otic

Class Summary

Topical and systemic antibiotics are used in the treatment of CSOM. Fluoroquinolone otic preparations, with or without a corticosteroid, are excellent options for topical treatment. Aminoglycoside otics may also be used, but monitoring of vestibular or cochlear toxicity is necessary. Representative examples of each class are listed below.

View full drug information

Ciprofloxacin (Cetraxal)

 

Ciprofloxacin is an ototopical fluoroquinolone containing hydrocortisone. This class of antimicrobial has a broad spectrum of activity. Additionally, fluoroquinolones do not cause vestibular or cochlear toxicity recognized with aminoglycosides.

View full drug information

Ciprofloxacin/dexamethasone combination (Ciprodex)

 

This combination of drugs treats bacterial infection and decreases the inflammation associated with bacterial infections.

View full drug information

Tobramycin (Tobrex)

 

Tobramycin is an ototopical aminoglycoside that may be combined with a corticosteroid. It has a long, successful history in the treatment of CSOM and is widely used today. The risk of vestibular or cochlear toxicity with prolonged use or use on the noninflamed middle ear exists; consider this when choosing to treat CSOM with this class of medication.

Tobramycin and dexamethasone (TobraDex)

 

This combination of drugs treats bacterial infection and decreases the inflammation associated with bacterial infections.

View full drug information

Piperacillin

 

Piperacillin inhibits the biosynthesis of cell wall mucopeptides and the stage of active multiplication; additionally, piperacillin shows antipseudomonal activity.

View full drug information

Ceftazidime (Fortaz, Tazicef)

 

Studies show ceftazidime to be an effective IV antibiotic for the systemic treatment of CSOM.[20, 21] It penetrates the middle ear mucosa effectively and does not cause vestibular or cochlear toxicity.

Previous
 
Contributor Information and Disclosures
Author

David Parry, MD  Staff Physician, Department of Otolaryngology-Head and Neck Surgery, ENT Associates of Children's Hospital, Boston

Disclosure: Nothing to disclose.

Coauthor(s)

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Additional Contributors

Anurag Jain, MBBS, FRCS(Ire), MS, FRCS(Oto), MS(Oto), DLO(RCSEngland) Specialist Registrar, Department of Otolaryngology, Pinderfields General Hospital, Wakefield, UK

Anurag Jain, MBBS, FRCS(Ire), MS, FRCS(Oto), MS(Oto), DLO(RCSEngland) is a member of the following medical societies: Association of Otolaryngologists of India, British Association of Otorhinolaryngologists, Head and Neck Surgeons, British Medical Association, Royal College of Surgeons in Ireland, and Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Jeffrey Robert Knight, MBChB, FRCS Consulting Surgeon, Department of Otolaryngology, Mayday University Hospital, London

Disclosure: Nothing to disclose.

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Peter A Weisskopf, MD Neurotologist, Arizona Otolaryngology Consultants; Head, Section of Neurotology, Barrow Neurological Institute

Peter A Weisskopf, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American College of Surgeons

Disclosure: Nothing to disclose.

References

  1. Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol. May 2009;123 Suppl 31:81-9. [Medline].

  2. Wright D, Safranek S. Treatment of otitis media with perforated tympanic membrane. Am Fam Physician. Apr 15 2009;79(8):650, 654. [Medline].

  3. Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol. May 2008;122(5):442-6. [Medline].

  4. McKenzie W, Brothwell D. Disease in the Ear. Disease in Antiquity. 1967;464-73.

  5. Gregg JB, Steele JP, Holzhueter A. Roentgenographic evaluation of temporal bones from South Dakota Indian burials. American Journal of Physical Anthropology. 1965;23:51-62.

  6. Rathbun TA, Mallin R. Middle ear disease in a prehistoric Iranian population. Bull N Y Acad Med. Dec 1977;53(10):901-5. [Medline]. [Full Text].

  7. Meyerhoff WL, Kim CS, Paparella MM. Pathology of chronic otitis media. Ann Otol Rhinol Laryngol. Nov-Dec 1978;87(6 Pt 1):749-60. [Medline].

  8. Kenna MA. Microbiology of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988;97(suppl 131):9-10.

  9. Kenna MA. Etiology and Pathogenesis of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988;97(Suppl 131):16-17.

  10. Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol. May 2009;123 Suppl 31:81-9. [Medline].

  11. Wright D, Safranek S. Treatment of otitis media with perforated tympanic membrane. Am Fam Physician. Apr 15 2009;79(8):650, 654. [Medline].

  12. van der Veen EL, Schilder AG, van Heerbeek N, et al. Predictors of chronic suppurative otitis media in children. Arch Otolaryngol Head Neck Surg. Oct 2006;132(10):1115-8. [Medline].

  13. Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol. May 2008;122(5):442-6. [Medline].

  14. Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am. Dec 2006;39(6):1237-55. [Medline].

  15. Dohar JE. Old and New Ototopical Agents for the Acute and Chronic Draining Ear. Seminars in Otitis Media Management. 1. 1998;1-14.

  16. Dohar JE, Alper CM, Rose EA, Doyle WJ, Casselbrant ML, Kenna MA. Treatment of chronic suppurative otitis media with topical ciprofloxacin. Ann Otol Rhinol Laryngol. Oct 1998;107(10 Pt 1):865-71. [Medline].

  17. Dohar JE, Kenna MA, Wadowsky RM. Therapeutic implications in the treatment of aural Pseudomonas infections based on in vitro susceptibility patterns. Arch Otolaryngol Head Neck Surg. Sep 1995;121(9):1022-5. [Medline].

  18. Roland PS, Dohar JE, Lanier BJ, Hekkenburg R, Lane EM, Conroy PJ. Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic solution in the treatment of granulation tissue in children with acute otitis media with otorrhea through tympanostomy tubes. Otolaryngol Head Neck Surg. Jun 2004;130(6):736-41. [Medline].

  19. Consensus Panel, Hannley MT, Dennenny III JC. Use of Ototopical Antibiotics in Treating 3 Common Ear Diseases. Otol Head Neck Surg. 2000;934-40.

  20. Somekh E, Cordova Z. Ceftazidime versus aztreonam in the treatment of pseudomonal chronic suppurative otitis media in children. Scand J Infect Dis. 2000;32(2):197-9. [Medline].

  21. Bégué P, Garabédian EN, Bertrand C, Aubert B, Chiche D. Penetration of ceftazidime into middle ear fluid in children with otitis media with effusion. Laryngoscope. May 1998;108(5):662-4.

 
Previous
Next
 
Anatomy of the external and middle ear.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.