Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-19T12:22:51.370Z Has data issue: false hasContentIssue false

A contemporary overview on the enigma of managing recalcitrant or intractable post-operative otorrhoea following middle-ear surgery: perspectives, principles and practices

Published online by Cambridge University Press:  24 March 2022

A Kumar Pandey
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
S Hernot
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
A ul Haq
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
C Bansal*
Affiliation:
Department of ENT, Satya Pal Wahi ONGC Hospital, Dehradun, India
M Kaintura
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
A Bhardwaj
Affiliation:
Department of Pathology, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
A Varma
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
F Anjum
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
A Kumawat
Affiliation:
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, India
*
Author for correspondence: Dr C Bansal, Department of ENT, Satya Pal Wahi ONGC Hospital, Dehradun, Uttarakhand, India E-mail: drchetanent@yahoo.in

Abstract

Background

A common problem in otological surgeries is the persistence of ear discharge in a patient who has undergone middle-ear reconstructive surgery, despite an intact graft. There is a dearth of knowledge in the literature on treatment strategies in such post-operative cases of recalcitrant otorrhoea.

Method

This was a retrospective observational descriptive study conducted on 45 patients who fitted the criteria for recalcitrant post-operative otorrhoea. All 45 patients showed no response to conservative treatment for 14 days from onset of discharge. Therefore, these patients were then given antiseptic ear drops.

Results

Thirty patients out of 45 showed a good response to antiseptic ear drops and achieved a dry ear at the end of the treatment.

Conclusion

In patients with recalcitrant otorrhoea with or without granulations after middle-ear reconstruction surgery, this study found that topical antiseptic ear drops, particularly those using boric acid powder, are more effective than topical antibiotic drops.

Type
Main Article
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr C Bansal takes responsibility for the integrity of the content of the paper

References

Committee on Conservation of Hearing, American Academy of Ophthalmology and Otolaryngology. Standard classification for surgery of chronic ear disease. Arch Otol 1965;81:204Google Scholar
Ekvall, L. Total middle ear reconstruction. Acta Otolaryngol 1973;75:279–81CrossRefGoogle ScholarPubMed
Gyo, K, Hirata, Y, Yanagihara, N. Changes in bacterial flora in the tympanic cavity following tympanoplasty. Otorhino Clinic 1993;86:1403–7Google Scholar
Palva, T, Hallstrom, O. Bacteriology of chronic otitis media. Arch Otolaryngol 1965;82:359–64CrossRefGoogle ScholarPubMed
Govaerts, PJ, Raemaekers, J, Verlinden, A, Kalai, M, Somers, T, Offeciers, FE. Use of antibiotic prophylaxis in ear surgery. Laryngoscope 1998;108:107–10CrossRefGoogle ScholarPubMed
Sayin, Z, Ucan, US, Sakmanoglu, A. Antibacterial and antibiofilm effects of boron on different bacteria. Biol Trace Elem Res 2016;173:241–6CrossRefGoogle ScholarPubMed
Zan, R, Hubbezoglu, I, Ozdemir, AK, Tunc, T, Sumer, Z, Alici, O. Antibacterial effect of different concentration of boric acid against enterococcus faecalis biofilms in root canal. Marmara Dent J 2013;1:7680Google Scholar
Shenoy, SB, Gadag, RP, Megalamani, SB, Mushannavar, AS. Comparison between vinegar wash and culture based oral antibiotic therapy in active chronic suppurative otitis media. Int J Otorhinolaryngol Head Neck Surg 2017;3:204–9CrossRefGoogle Scholar
Daniel, SJ, Kozak, FK, Fabian, MC, Hekkenberg, R, Hruby, LE, Harjee, KS et al. Guidelines for the treatment of tympanostomy tube otorrhea. J Otolaryngol 2005;34:60–3Google ScholarPubMed
Stewart, PS, Costerton, JW. Antibiotic resistance of bacteria in biofilms. Lancet 2001;358:135–8CrossRefGoogle ScholarPubMed
Nagoba, BS, Suryawanshi, NM, Wadher, B, Selkar, S. Acidic environment and wound healing: a review. Wounds 2015;27:511Google Scholar
Acuin, J. Chronic suppurative otitis media: burden of illness and management options. Geneva: World Health Organization, 2004Google Scholar
Verhoeff, M, Van der Veen, EL, Rovers, MM, Sanders, EA, Schilder, AG. Chronic suppurative otitis media: a review. Int J Pediatr Otorhinolaryngol 2006;70:112CrossRefGoogle ScholarPubMed
Fleischer, W, Reimer, K. Povidone-iodine in antisepsis-sate of art. Dermatology 1997;195:39CrossRefGoogle Scholar
Perez, R, Freeman, S, Sohmer, H, Sichel, JY. Vestibular and cochlear ototoxicity of topical antispetics assessed by evoked potentials. Laryngoscope 2000;110:1522–7CrossRefGoogle Scholar
Aursnes, J. Ototoxic effects of iodine disinfectants. Acta Otolaryngol 1982;93:219–26CrossRefGoogle ScholarPubMed
Jaya, C, Job, A, Mathai, E. Evaluation of topical povidone-iodine in chronic suppurative otitis media. Arch Otolaryngol Head Neck Surg 2003:129:1098–100CrossRefGoogle ScholarPubMed
Johnston, CS, Gaas, CA. Vinegar: medicinal uses and antiglycemic effect. Med Gen Med 2006;8:61Google ScholarPubMed
Jones, EH, McLain, PG. Does acid pH inhibit bacterial growth in the external ear canal. Laryngoscope 1961;71:928–36CrossRefGoogle ScholarPubMed
Kveton, JF. Open cavity mastoid operation. In: Gulya, AJ, Minor, LB, Poe, DS, eds. Surgery of the ear, 6th edn. Connecticut: People's Medical Publishing House, 2010;520Google Scholar
Fabricant, ND, Perlstein, MA. pH of the cutaneous surface of the external auditory canal. Arch Otolaryngol 1949;49:201–9CrossRefGoogle ScholarPubMed
Maley, AM, Arbiser, JL. Gentian Violet: a 19th century drug re-emerges in the 21st century. Exp Dermatol 2013;22:775–80CrossRefGoogle ScholarPubMed
Ingraham, MA. The bacteriostatic action of gentian violet and dependence on the oxidation-reduction potential. J Bacteriol 1933;26:573–98CrossRefGoogle ScholarPubMed
Perry, BN, Govindarajan, B, Bhandarkar, SS et al. Pharmacologic blockade of angiopoietin-2 is efficacious against model hemangiomas in mice. J Invest Dermatol 2006;126:2316–22CrossRefGoogle ScholarPubMed
Levin, D, Lovely, T, Klekowski, E. Light-enhanced genetic toxicity of crystal violet. Mutat Res 1982;103:283–8CrossRefGoogle ScholarPubMed
Harrelson, W, Mason, R. Microsomal reduction of gentian violet. Evidence for cytochrome P-450-catalyzed free radical formation. Mol pharmacol 1982;22:239–42Google ScholarPubMed
Stearn, EW, Stearn, AE. The mechanical behavior of dyes, especially gentian violet, in bacteriological media. J Bacteriol 1923;8:567–72CrossRefGoogle ScholarPubMed
Gustafsson, P, Nordström, K, Normark, S. Outer penetration barrier of Escherichia coli K-12: kinetics of the uptake of gentian violet by wild type and envelope mutants. J Bacteriol 1973;116:893900CrossRefGoogle ScholarPubMed
Hoffmann, ME, Jang, J, Moreno, SN, Docampo, R. Inhibition of protein synthesis and amino acid transport by crystal violet in Trypanosoma cruzi. J Eukaryot Microbiol 1995;42:293–7CrossRefGoogle ScholarPubMed
Fry, BA. Basic triphenylmethane dyes and the inhibition of glutamine synthesis by Staphylococcus aureus. J Gen Microbiol 1957;16:341–9CrossRefGoogle ScholarPubMed
Moreno, SN, Gadelha, FR, Docampo, R. Crystal violet as an uncoupler of oxidative phosphorylation in rat liver mitochondria. J Biol Chem 1988;263:12493–9CrossRefGoogle ScholarPubMed
Park, JT. Uridinediphosphate derivatives in Staphylococcus aureus treated with crystal violet or various antibiotics. Federation Proc 1954;13:271Google Scholar
Adriztina, I, Adenin, LI, Lubis, YM. Efficacy of boric acid as a treatment of choice for chronic suppurative otitis media and its ototoxicity. Korean J Fam Med 2018;39:29CrossRefGoogle ScholarPubMed
Yilmaz, MT. Minimum inhibitory and minimum bactericidal concentrations of boron compounds against several bacterial strains. Turk J Med Sci 2012;42:1423–9Google Scholar
Meers, PD, Chow, CK. Bacteriostatic and bactericidal actions of boric acid against bacteria and fungi commonly found in urine. J Clin Pathol 1990;43:484–7CrossRefGoogle ScholarPubMed
Moshi, NH, Minja, BM, Ole-Lengine, L, Mwakagile, DS. Bacteriology of chronic otitis media in Dar es Salaam, Tanzania. East Afr Med J 2000;77:20–2Google ScholarPubMed
Loock, JW. A randomised controlled trial of active chronic otitis media comparing courses of eardrops versus one-off topical treatments suitable for primary, secondary and tertiary healthcare settings. Clin Otolaryngol 2012;37:261–70CrossRefGoogle ScholarPubMed
Lefebvre, MA, Quach, C, Daniel, SJ. Chronic suppurative otitis media due to nontuberculous mycobacteria: a case of successful treatment with topical boric acid. Int J Pediatr Otorhinolaryngol 2015;79:1158–60CrossRefGoogle ScholarPubMed
Roland, PS. The formation and management of middle ear granulation tissue in chronic ear disease. Ear Nose Throat J 2004;83:58CrossRefGoogle ScholarPubMed
Puls, T. Myringoplasty: is molded collagen xenograft a valid alternative for fresh temporalis fascia? Acta Otorhinolaryngol Belg 1996;50:111–4Google ScholarPubMed