DOES TOPICAL ANTIBIOTIC-PROPHYLAXIS REDUCE POSTTYMPANOSTOMY TUBE OTORRHEA - A METAANALYSIS

Purulent otorrhea is the most common complication of tympanostomy tube (TT) insertion. It may occur in the postoperative period or at any ti me during the sojourn of the tube. The efficacy of topical antimicrobi al prophylaxis against purulent postoperative otorrhea (PPO) has been examined in 5 prospective, randomized studies; all demonstrated a redu ction in PPO from topical antimicrobial prophylaxis, but in only 1 stu dy was the difference statistically significant. Because the 5 studies used 2 different experimental designs-by-patient, and by-ear - a sing le meta-analysis could not be done. However, the by-patient studies me t the criteria for meta-analysis, which demonstrated a combined odds r atio of 0.12 (95% confidence interval 0.04 to 0.37, p =.0002). This re presents an 85% reduction in otorrhea, which is judged to be clinicall y as well as statistically significant. We conclude from the available evidence that prophylactic use of topical antimicrobial agents follow ing TT insertion consistently reduces the rate of PPO. However, the lo w incidence of PPO and the heterogeneity of the published studies prev ent making a final judgment for or against the continued use of these agents. Therefore, given that these potentially ototoxic agents are fr equently administered to prevent postoperative otorrhea, further study of this subject is warranted. In the meantime, we recommend judicious use of these agents following TT insertion in those cases at higher r isk for PPO, namely those with mucoid or purulent effusion.