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Question 1: Are topical or oral antibiotics best for treating tympanostomy tube otorrhoea?
  1. Waseem Ahmed1,
  2. Irfan Syed2,
  3. Somiah Siddiq3,
  4. David Allin4,
  5. David Albert1
  1. 1 Department of ENT, Great Ormond Street Hospital, London, UK
  2. 2 University Hospital Lewisham, London, UK
  3. 3 Department of ENT, Birmingham Children’s Hospital, Birmingham, UK
  4. 4 Department of ENT, Lewisham Hospital, London, UK
  1. Correspondence to Waseem Ahmed, Department of ENT, Great Ormond Street Hospital, London WC1N 3JH, UK; waseem.ahmed6{at}nhs.net

https://doi.org/10.1136/archdischild-2017-313854

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    Scenario

    A 4-year-old boy presents to your clinic with his mother. Mum tells you that his left ear has been discharging for 5 days now and thinks it may be infected. On examining the child’s ear you notice purulent discharge within the left ear canal and a grommet in-situ. You wonder whether oral or topical antibiotics may be appropriate in this case.

    Question

    In children with tympanostomy tubes (patient) that develop ear discharge, are topical antibiotics (intervention) superior to systemic antibiotics (comparison) when treating otorrhoea (outcome)?

    Search strategy

    Please see (online supplementary appendix) below for the detailed search strategy used to answer this question.

    Supplementary file 1

    [SP1.pdf]

    Secondary sources

    An initial TRIP Database (clinical search engine) identified one Cochrane review, subsequently excluded as the four studies included in the analysis do not compare oral and topical antibiotic treatments.1

    Secondary sources also noted guidelines published by Rosenfeld et al recommending use of topical antibiotics eardrops only for children with uncomplicated tympanostomy tube otorrhoea.2 Other sources searched included Best Practice and Best Evidence Statement (BESt), which produced no relevant results. The Cochrane Database and PubMed Clinical Queries both suggested the review originally identified on TRIP (and subsequently excluded).

    Primary sources

    Primary sources searched included EMBASE (1974 to April 2017 week 4) and PubMed (1950 to April 2017 week 4), both identifying two randomised control trials (RCTs) and the latter an additional one.3–5

    The final study was found while critically appraising von Dongen et al.6

    The following key words were used: (otorrhoea OR ear discharge or otorrhoea) AND (ventilation tube OR grommet OR …

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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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