Conclusion

A stepwise approach, graded or balanced in reference to the severity, risks, and costs of the otorrhea problem, is advised. Typically, the initial management includes topical and/or oral medications directed at likely pathogens. In recalcitrant cases, antimicrobial therapy guided by Gram stain, culture, and sensitivity data acquired from a representative specimen obtained through the lumen of the tympanostomy tube is helpful. If otorrhea persists for several weeks despite these usual treatment measures, additional causative factors should be considered. Such additional factors include resistant or unusual microorganisms, susceptible microorganisms sequestered in a reservoir (e.g., smoldering mastoiditis, or a previously placed unwittingly retained tympanostomy tube) not accessible to topical or systematically administered drugs, granulation tissue, eustachian tube reflux, immunodeficiency, chole-steatoma, and systemic or neoplastic disorders.

REFERENCES

Behar and Todd—CHAPTER 36

1. Per-Lee JH. Long-term middle ear ventilation. Laryngoscope 1981;91:1063-1072

2. Mandel EM, Casselbrant ML, Kurs-Lasky M. Acute otorrhea: bacteriology of a common complication of tympanostomy tubes. Ann OtolRhinolLaryngol 1994;103:713-718

3. Giebink GS, Daly K, Buran DJ, et al. Predictors for postoperative otorrhea following tympanostomy tube insertion. Arch Otolaryngol Head Neck Surg 1992;118:491-494

4. Luxford WM, Sheehy JL. Myringotomy and ventilation tubes: a report of 1,568 ears. Laryngoscope 1982;92:1293-1297

5. Paradise JL, Bluestone CD. Early treatment of the universal otitis media of infants with cleft palate. Pediatrics 1974;53: 48-54

6. Debruyne F, Jorissen M, Peolmans J. Otorrhea during transtympanic ventilation. Am J Otol 1988;9:316-317

7. Alberti PW. Myringotomy and ventilating tubes in the 19th century. Laryngoscope 1994;84:805-815

8. Crysdale WS. Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants (Braganza et al., 1991) (letter). Cleft Palate Craniofacial J 1992;29:97

9. Braganza RA, Kearns DB, Burton DM, et al. Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants. Cleft Palate Craniofacial 1991;28:305-307

10. Masin JS, Hostoffer RW, Arnold JE. Otitis media following tympanostomy tube placement in children with IgG2 deficiency. Laryngoscope 1995;105:1188-1190

11. Postma DS, Poole MD, Wu SM, Tober R. The impact of day care on ventilation tube insertion. Int J Pediatr Otorhino-laryngol 1997;41:253-262

12. Valtonen H, Qvarnberg Y, Puhakka H, Nuutinen J. Early post-tympanostomy otorrhea in children under 17 months of age. Acta Otolaryngol (Stockh) 1997;117:569-573

13. Scott BA, Strunk CL. Post-tympanostomy otorrhea: a randomized clinical trial of topical prophylaxis. Otolaryngol Head Neck Surg 1992;106:34-41

14. Hester TO, Jones RO, Archer SM, Haydon RC. Prophylactic antibiotic drops after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg 1995;121:445-448

15. Baldwin RL, Aland J. The effects of povidone-iodine preparation on the incidence of post-tympanostomy tube otorrhea. Otolaryngol Head Neck Surg 1990;102:631-634

16. Todd NW. Otitis media and eustachian tube caliber. Acta Otolaryngol (Stockh) 1983;404:1-17

17. Scott BA, Strunk CL Jr. Posttympanostomy otorrhea: the efficacy of canal preparation. Laryngoscope 1992;102:1103-1107

18. Gross RD, Burgess LP, Hall DJ, et al. Middle ear irrigation in the prevention of otorrhea after tympanostomy tube placement. Laryngoscope 1999;110:246-249

19. Gates GA, Avery C, Prihoda TJ, Holt GR. Post-tympanos-tomy otorrhea. Laryngoscope 1986;96:630-634

20. Karlan MS, Skobel B, Grizzard M, et al. Myringotomy tube materials: bacterial adhesion and infection. Otolaryngol Head Neck Surg 1980;88:783-795

21. Chole RA, Hubbell RN. Antimicrobial activity of silastic tym-panostomy tubes impregnated with silver oxide: a doubleblind randomized multicenter trial. Arch Otolaryngol Head Neck Surg 1995;121:562-565

22. Kinsella JB, Fenton J, Donnelly MJ, McShane DP. Tympanostomy tubes and early post-operative otorrhea. Int J Pediatr Otorhinolaryngol 1994;30:111-114

23. Salam MA, Cable HR. The use of antibiotic/steroid ear drops to reduce post-operative otorrhoea and blockage of ventilation tubes. A prospective study. JLaryngol Otol 1993;107:188-189

24. Daly KA, Giebink GS, Lindgren B, et al. Randomized trial of the efficacy of trimethoprim-sulfamethoxazole and prednisone in preventing post-tympanostomy tube morbidity. Pediatr Infect Dis J 1995;14:1068-1074

25. Gates GA, Avery C, Prihoda TJ, Holt GR. Delayed onset post-tympanostomy otorrhea. Otolaryngol Head Neck Surg 1988; 98:111-115

26. Brook I, Yocum P, Shah K. Aerobic and anaerobic bacteriology of otorrhea associated with tympanostomy tubes in children. Acta Otolaryngol (Stockh) 1998;118:206-210

27. Smith BM, Myers MG. The penetration of gentamycin and neomycin into perilymph across the round window membrane. Otolaryngol Head Neck Surg 1978;87:888-891

28. Wright CG, Meyerhoff WL. Ototoxicity of otic drops applied to the middle ear in the chinchilla. Am J OOtolaryngol 1984;5: 166-176

29. Merifield DO, Parker NJ, Nicholson NC. Therapeutic management of chronic suppurative otitis media with otic drops. Otolaryngol Head Neck Surg 1993;109:77-82

30. Lundy LB, Graham MD. Ototoxicity and ototopical medications: a survey of otolaryngologists. Am J Otol 1993;14:141-146

31. Welling DB, Forrest LA, Goll F 3rd. Safety of ototopical antibiotics. Laryngoscope 1995;105:472-474

32. American Academy of Otolaryngology—Head and Neck Surgery. Policy statement 1420 Topical Antibiotic Drops, adopted 7/9/94, reaffirmed 3/1/98, Alexandria, Virginia, AAO-HNS Bulletin, October 1998.

33. Van Gickel CJW, Bruintjes TD, Huizing EH. Allergy due to topical medications in chronic otitis externa and chronic otitis media. Clin Otolaryngol 1995;20:326-328

34. Lauerma AI, Reitamo S. Contact allergy to corticosteroids. J Am Acad Dermatol 1993;28:618-622

35. Parker GS, Tami TA, Maddox MR, et al. The effect of water exposure after tympanostomy tube insertion. Am J Otolaryn-gol 1994;15:193-196

36. Hebert RL II, King GE, Bent JP III. Tympanostomy tubes and water exposure: a practical model. Arch Otolaryngol Head Neck Surg 1998;124:1118-1121

37. Cunningham MJ, Eavey RD, Krouse JH, Kiskaddon RM. Tympanostomy tubes: experience with removal. Laryngoscope 1993;103:659-662

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