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Martin J Burton - One of the best experts on this subject based on the ideXlab platform.
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withdrawn Ear Drops for the removal of Ear wax
Cochrane Database of Systematic Reviews, 2018Co-Authors: Martin J Burton, Carolyn DoreeAbstract:Background Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with Ear trouble. Treatment for this condition often involves use of a wax softening agent (cerumenolytic) to disperse the cerumen, reduce the need for, or facilitate syringing, but there is no consensus on the effectiveness of the variety of cerumenolytics in use. Objectives To assess the effectiveness of Ear Drops (cerumenolytics) for the removal of symptomatic Ear wax. SEarch methods We sEarched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008 issue 2); MEDLINE; EMBASE; CINAHL; ISI Proceedings; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent sEarch was April 2008. Selection criteria We identified all randomised controlled trials in which a cerumenolytic was compared with no treatment, a placebo, or other cerumenolytics in participants with obstructing or impacted Ear wax, and in which the proportion of participants with sufficient clEarance of the external canal to make further mechanical clEarance unnecessary (primary outcome measure) was stated or calculable. Data collection and analysis The two authors reviewed all the retrieved trials and applied the inclusion criteria independently. Main results Nine trials satisfied the inclusion criteria. In all, 679 participants received one of 11 different cerumenolytics. One trial compared active treatments with no treatment, three compared active treatments with water or a saline 'placebo', and all nine trials compared two or more active treatments. Eight trials included syringing as a secondary intervention.Overall, results were inconclusive. The majority of comparisons showed no difference between treatments. Meta-analysis of two high quality trials produced a statistical difference in favour of triethanolamine polypeptide over saline in preventing the need for syringing, but no other significant differences between treatments.In three trials of high to moderate quality, no difference was found between the effectiveness of either sodium bicarbonate Ear Drops, chlorbutanol, triethanolamine polypeptide oleate condensate or docusate sodium liquid versus a sterile water or saline 'placebo'.One trial of moderate methodological quality found all three treatments - sodium bicarbonate Ear Drops, chlorbutanol and sterile water - to be significantly better than no treatment at preventing the need for syringing.None of the higher quality trials demonstrated superiority of one agent over another in direct comparisons. Authors' conclusions Trials have been heterogeneous and generally of low or moderate quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic Ear wax. Using Drops of any sort appEars to be better than no treatment, but it is uncertain if one type of drop is any better than another. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo, no treatment or both.
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extracts from the cochrane library interventions for the prevention of postoperative Ear discharge after insertion of ventilation tubes grommets in children
Otolaryngology-Head and Neck Surgery, 2013Co-Authors: Anne G M Schilder, Martin J Burton, Jennifer J Shin, Richard M RosenfeldAbstract:The ‘‘Cochrane Corner’’ is a section in the journal that highlights systematic reviews relevant to otolaryngology– head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review, ‘‘Interventions for the Prevention of Postoperative Ear Discharge after Insertion of Ventilation Tubes (Grommets) in Children,’’ that concludes if a surgeon has a high rate of postoperative otorrhea in children, then saline irrigation or antibiotic Ear Drops at the time of surgery would significantly reduce that rate. If topical Drops are chosen, a single application at the time of surgery is suggested to reduce the cost and potential for ototoxic damage (if applicable).
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extracts from the cochrane library
Otolaryngology-Head and Neck Surgery, 2011Co-Authors: Anne G M Schilder, Martin J Burton, Jennifer J Shin, Richard RosenfeldAbstract:The “Cochrane Corner” is a section in the journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review, “Interventions for the Prevention of Postoperative Ear Discharge after Insertion of Ventilation Tubes (Grommets) in Children,” that concludes if a surgeon has a high rate of postoperative otorrhea in children, then saline irrigation or antibiotic Ear Drops at the time of surgery would significantly reduce that rate. If topical Drops are chosen, a single application at the time of surgery is suggested to reduce the cost and potential for ototoxic damage (if applicable).
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Ear Drops for the removal of Ear wax
Cochrane Database of Systematic Reviews, 2009Co-Authors: Martin J Burton, Carolyn DoreeAbstract:Background Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with Ear trouble. Treatment for this condition often involves use of a wax softening agent (cerumenolytic) to disperse the cerumen, reduce the need for, or facilitate syringing, but there is no consensus on the effectiveness of the variety of cerumenolytics in use. Objectives To assess the effectiveness of Ear Drops (cerumenolytics) for the removal of symptomatic Ear wax. SEarch methods We sEarched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008 issue 2); MEDLINE; EMBASE; CINAHL; ISI Proceedings; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent sEarch was April 2008. Selection criteria We identified all randomised controlled trials in which a cerumenolytic was compared with no treatment, a placebo, or other cerumenolytics in participants with obstructing or impacted Ear wax, and in which the proportion of participants with sufficient clEarance of the external canal to make further mechanical clEarance unnecessary (primary outcome measure) was stated or calculable. Data collection and analysis The two authors reviewed all the retrieved trials and applied the inclusion criteria independently. Main results Nine trials satisfied the inclusion criteria. In all, 679 participants received one of 11 different cerumenolytics. One trial compared active treatments with no treatment, three compared active treatments with water or a saline 'placebo', and all nine trials compared two or more active treatments. Eight trials included syringing as a secondary intervention. Overall, results were inconclusive. The majority of comparisons showed no difference between treatments. Meta-analysis of two high quality trials produced a statistical difference in favour of triethanolamine polypeptide over saline in preventing the need for syringing, but no other significant differences between treatments. In three trials of high to moderate quality, no difference was found between the effectiveness of either sodium bicarbonate Ear Drops, chlorbutanol, triethanolamine polypeptide oleate condensate or docusate sodium liquid versus a sterile water or saline 'placebo'. One trial of moderate methodological quality found all three treatments - sodium bicarbonate Ear Drops, chlorbutanol and sterile water - to be significantly better than no treatment at preventing the need for syringing. None of the higher quality trials demonstrated superiority of one agent over another in direct comparisons. Authors' conclusions Trials have been heterogeneous and generally of low or moderate quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic Ear wax. Using Drops of any sort appEars to be better than no treatment, but it is uncertain if one type of drop is any better than another. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo, no treatment or both.
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evidence review and ent uk consensus report for the use of aminoglycoside containing Ear Drops in the presence of an open middle Ear
Clinical Otolaryngology, 2007Co-Authors: Js Phillips, Martin J Burton, Mw Yung, Iain R C SwanAbstract:Background and objectives of review: The use of aminoglycoside Drops in the presence of a perforation/grommet is still a common practice amongst the UK ENT community, in spite of theoretical risk of ototoxicity. Mindful of the need to produce clinical guidelines based on the best available evidence, it was the intention of the Clinical Audit and Practice Advisory Group of the British Association of Otolaryngologists – Head and Neck Surgeons (ENT-UK) to produce evidence-based guidelines. In the absence of good evidence, intentions were shifted towards producing consensus guidelines using validated methodology. Type of review: Literature review, review of international guidelines and consensus guidelines. SEarch strategy: A MEDLINE literature sEarch (1966 to August 2006) was conducted, using the following strategies: ‘ototoxicity and Drops’, ‘ototoxic and Drops’, ‘vestibulotoxicity and Drops’, ‘vestibulotoxic and Drops’, ‘cochleotoxicity and Drops’, ‘cochleotoxic and Drops’. Foreign language articles were not excluded. Results of the literature review: The inclusion of foreign language articles and manually sEarching the reference sections of identified articles revealed further evidence not considered in previous reviews on this subject. However, the available ‘evidence’ that does exist remains to be of poor quality, consisting of data from a number of case reports and small case series. Prospective studies into the ototoxic effects of aminoglycoside Ear Drops either support their use but lack power to statistically confirm this, or are performed in conditions that are not representative of normal clinical conditions. Evaluation method: In the light of issues raised from the literature review, a questionnaire was produced. The questionnaire was initially completed by council members of the British Society of Otology, then revised and presented at a meeting of the British Society of Otology, where a consensus panel was formed. Conclusions: ENT-UK recommends that when treating a patient with a discharging Ear, in whom there is a perforation or patent grommet: if a topical aminoglycoside is used, this should only be in the presence of obvious infection. Topical aminoglycosides should be used for no longer than 2 weeks. The justification for using topical aminoglycosides should be explained to the patient. Baseline audiometry should be performed, if possible or practical, before treatment with topical aminoglycosides.
Patrick J Antonelli - One of the best experts on this subject based on the ideXlab platform.
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risk for tympanic membrane perforation after quinolone Ear Drops for acute otitis externa
Clinical Infectious Diseases, 2019Co-Authors: Xi Wang, Adel Alrwisan, Almut G Winterstein, Patrick J AntonelliAbstract:Background This study examined whether the use of quinolone Ear Drops increased the risk of perforation with intact tympanic membranes and acute otitis externa (AOE). Methods This was a retrospective cohort study using Medicaid clinical encounter and pharmacy billing records from 1999 through 2010. Children and adults had to have 24 months continuous enrollment in Medicaid prior to the first antibiotic Ear drop dispensing (index date), and they had to maintain their enrollment for at least 18 months thereafter. Included Ear Drops were ofloxacin, ciprofloxacin plus hydrocortisone, ciprofloxacin plus dexamethasone, and neomycin plus hydrocortisone. Tympanic membrane perforation (TMP) was identified as 2 inpatient or outpatient encounters associated with TMP diagnosis at least 30 days apart. A Cox regression model adjusting for patient demographics, calendar yEar, and the number of Ear drop prescriptions was used to compare TMP risk between quinolone and neomycin-exposed patients. Results A total of 94 333 patients entered the study cohort. Use of quinolone Ear Drops was associated with increased risk for TMP compared with neomycin plus hydrocortisone, with an adjusted hazard ratio of 2.26 (95% confidence interval [CI], 1.34-3.83). Adjusted hazard ratios were 2.53 (95% CI, 1.27-5.05) for ofloxacin, 2.24 (95% CI, 1.03-4.85) for ciprofloxacin plus hydrocortisone, and 2.30 (95% CI, 1.09-4.87) for ciprofloxacin plus dexamethasone. Sensitivity analyses were consistent with the primary analysis. Conclusions Use of quinolone Ear Drops to treat AOE is associated with a previously unreported increased risk of developing TMPs. Selection of otic preparations to treat self-limited conditions with intact tympanic membranes should consider TMP risk.
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Commercial Quinolone Ear Drops Cause Perforations in Intact Rat Tympanic Membranes.
Otology & neurotology : official publication of the American Otological Society American Neurotology Society [and] European Academy of Otology and Neu, 2019Co-Authors: Carolyn O. Dirain, David N. Karnani, Patrick J AntonelliAbstract:Hypothesis:Commercial quinolone Ear Drops may promote the development of perforations (TMPs) in intact tympanic membrane (TMs).Background:Quinolone Ear Drops have been associated with TMPs after myringotomy +/- tube placement in a drug-specific manner and potentiation by steroids.Methods:Rats were r
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effects of common Ear Drops on tympanic membrane healing in rats
Otolaryngology-Head and Neck Surgery, 2018Co-Authors: Carolyn O. Dirain, Brendan Kosko, Patrick J AntonelliAbstract:ObjectiveCiprofloxacin + dexamethasone Ear Drops have been associated with higher rates of tympanic membrane perforations than ofloxacin. This was thought to be an effect of the steroid; however, ciprofloxacin (sans steroid) has been found to be more toxic to tympanic membrane fibroblasts than ofloxacin in vitro. This study aimed to compare the effect of these agents on tympanic membrane healing in vivo.Study DesignControlled animal study.SettingAcademic resEarch laboratory.MethodsPerforations were created in 54 rats with a carbon dioxide laser. Rats were randomized to 6 groups (9/group), with 1 Ear receiving ofloxacin, ciprofloxacin, dexamethasone, ofloxacin + dexamethasone, ciprofloxacin + dexamethasone, or neomycin, and the contralateral Ear receiving saline twice daily for 10 days. Healing was assessed over 40 days.ResultsOfloxacin did not delay healing relative to saline. All other treatments delayed healing relative to ofloxacin at day 10 (P < .0001). Dexamethasone and ofloxacin + dexamethasone dela...
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quinolone Ear Drops after tympanostomy tubes and the risk of Eardrum perforation a retrospective cohort study
Clinical Infectious Diseases, 2017Co-Authors: Adel Alrwisan, Patrick J Antonelli, Almut G WintersteinAbstract:Background This study investigated whether quinolone Ear Drops, with or without corticosteroids, increase the risk of perforation requiring tympanoplasty following tympanostomy tube (TT) placement in children. Methods This was a retrospective cohort study using Medicaid encounter and pharmacy billing data from 29 US states between 1999 and 2006. Children <18 yEars old without predisposing factors for perforation during a 6-month look-back period entered the cohort after TT placement and first dispensing of antibiotic Ear Drops. Included Ear Drops were quinolones (ofloxacin, ciprofloxacin plus hydrocortisone, or ciprofloxacin plus dexamethasone) or neomycin plus hydrocortisone. Children were followed until end of 2006, end of Medicaid enrollment, or occurrence of study outcome. A Cox regression model, adjusted for age, sex, race/ethnicity, initial TT indication, reinsertion of TT, adenoidectomy, and number of Ear drop prescriptions was used to compare the rate of perforation between quinolone and neomycin plus hydrocortisone Ear drop-exposed children. Perforation was defined by its diagnosis code followed by a tympanoplasty code. Results A total of 96595 children entered the study cohort. Patients exposed to quinolone Ear Drops had a higher risk of perforation, with an adjusted hazard ratio of 1.61 (95% confidence interval [CI], 1.15-2.26). The adjusted hazard ratios were 1.49 (95% CI, 1.05-2.09) for ofloxacin, 1.94 (95% CI, 1.32-2.85) for ciprofloxacin plus hydrocortisone, and 2.00 (95% CI, 1.18-3.41) for ciprofloxacin plus dexamethasone. Conclusions Exposure of children with TT to quinolone Ear Drops is associated with increased risk of perforations requiring tympanoplasty, which appEars to be further exaggerated by corticosteroids. Clinicians should consider the risk of perforation and counsel patients/families accordingly when prescribing quinolone Ear Drops.
Iain R C Swan - One of the best experts on this subject based on the ideXlab platform.
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evidence review and ent uk consensus report for the use of aminoglycoside containing Ear Drops in the presence of an open middle Ear
Clinical Otolaryngology, 2007Co-Authors: Js Phillips, Martin J Burton, Mw Yung, Iain R C SwanAbstract:Background and objectives of review: The use of aminoglycoside Drops in the presence of a perforation/grommet is still a common practice amongst the UK ENT community, in spite of theoretical risk of ototoxicity. Mindful of the need to produce clinical guidelines based on the best available evidence, it was the intention of the Clinical Audit and Practice Advisory Group of the British Association of Otolaryngologists – Head and Neck Surgeons (ENT-UK) to produce evidence-based guidelines. In the absence of good evidence, intentions were shifted towards producing consensus guidelines using validated methodology. Type of review: Literature review, review of international guidelines and consensus guidelines. SEarch strategy: A MEDLINE literature sEarch (1966 to August 2006) was conducted, using the following strategies: ‘ototoxicity and Drops’, ‘ototoxic and Drops’, ‘vestibulotoxicity and Drops’, ‘vestibulotoxic and Drops’, ‘cochleotoxicity and Drops’, ‘cochleotoxic and Drops’. Foreign language articles were not excluded. Results of the literature review: The inclusion of foreign language articles and manually sEarching the reference sections of identified articles revealed further evidence not considered in previous reviews on this subject. However, the available ‘evidence’ that does exist remains to be of poor quality, consisting of data from a number of case reports and small case series. Prospective studies into the ototoxic effects of aminoglycoside Ear Drops either support their use but lack power to statistically confirm this, or are performed in conditions that are not representative of normal clinical conditions. Evaluation method: In the light of issues raised from the literature review, a questionnaire was produced. The questionnaire was initially completed by council members of the British Society of Otology, then revised and presented at a meeting of the British Society of Otology, where a consensus panel was formed. Conclusions: ENT-UK recommends that when treating a patient with a discharging Ear, in whom there is a perforation or patent grommet: if a topical aminoglycoside is used, this should only be in the presence of obvious infection. Topical aminoglycosides should be used for no longer than 2 weeks. The justification for using topical aminoglycosides should be explained to the patient. Baseline audiometry should be performed, if possible or practical, before treatment with topical aminoglycosides.
Belavendra Antonisamy - One of the best experts on this subject based on the ideXlab platform.
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evaluation of topical povidone iodine in chronic suppurative otitis media
Archives of Otolaryngology-head & Neck Surgery, 2003Co-Authors: C Jaya, Elizabeth Mathai, Belavendra AntonisamyAbstract:Objectives To evaluate if povidone-iodine (PVP-I) can be used topically in the treatment of chronic suppurative otitis media–tubotympanic disease and to compare it with ciprofloxacin hydrochloride Ear Drops. Design Prospective double-blind randomized study. Setting Academic tertiary medical center. Patients Forty patients with chronic suppurative otitis media were randomized into 2 groups. Intervention One group (19 patients) received 5% PVP-I Ear Drops, while the other group (21 patients) received 0.3% ciprofloxacin Ear Drops. Both were administered topically, 3 Drops 3 times daily for 10 days. These patients were followed up at weekly intervals for up to 4 weeks after commencing therapy. Results Clinical improvement at the end of study was 88% in the PVP-I group and 90% in the ciprofloxacin group. The most commonly isolated organism was Pseudomonas aeruginosa. In vitro resistance to ciprofloxacin was seen in 17% of organisms, while no resistance was seen for PVP-I. Conclusions To our knowledge, this is the first study to evaluate the efficacy of PVP-I as a topical agent in the treatment of chronic suppurative otitis media. The results show that clinically, topical PVP-I is as effective as topical ciprofloxacin, with a superior advantage of having no in vitro drug resistance. Also, there is an added benefit of reduced cost of therapy.
David T Liu - One of the best experts on this subject based on the ideXlab platform.
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biannual differences in interest peaks for web inquiries into Ear pain and Ear Drops infodemiology study
Journal of Medical Internet Research, 2021Co-Authors: Faris F Brkic, Gerold Besser, Martin Schally, Thomas Parzefall, Dominik Riss, Elisabeth Schmid, David T LiuAbstract:Background: The data retrieved with the online sEarch engine, Google Trends, can summarize internet inquiries into specified sEarch terms. This engine may be used for analyzing inquiry peaks for different medical conditions and symptoms. Objective: The aim of this study was to analyze World Wide Web interest peaks for “Ear pain,” “Ear infection,” and “Ear Drops.” Methods: We used Google Trends to assess the public online interest for sEarch terms “Ear pain,” “Ear infection,” and “Ear Drops” in 5 English and non–English-speaking countries from both hemispheres based on time series data. We performed our analysis for the time frame between January 1, 2004, and December 31, 2019. First, we assessed whether our sEarch terms were most relevant to the topics of Ear pain, Ear infection, and Ear Drops. We then tested the reliability of Google Trends time series data using the intraclass correlation coefficient. In a second step, we computed univariate time series plots to depict peaks in web-based interest. In the last step, we used the cosinor analysis to test the statistical significance of seasonal interest peaks. Results: In the first part of the study, it was revealed that “Ear infection,” “Ear pain,” and “Ear Drops” were the most relevant sEarch terms in the noted time frame. Next, the intraclass correlation analysis showed a moderate to excellent reliability for all 5 countries’ 3 primary sEarch terms. The subsequent analysis revealed winter interest peaks for “Ear infection” and “Ear pain”. On the other hand, the World Wide Web sEarch for “Ear Drops” peaked annually during the summer months. All peaks were statistically significant as revealed by the cosinor model (all P values <.001). Conclusions: It can be concluded that individuals affected by otitis media or externa, possibly the majority, look for medical information online. Therefore, there is a need for accurate and easily accessible information on these conditions in the World Wide Web, particularly on differentiating signs and therapy options. Meeting this need may facilitate timely diagnosis, proper therapy, and eventual circumvention of potentially life-threatening complications.
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Biannual Differences in Interest Peaks for Web Inquiries Into Ear Pain and Ear Drops: Infodemiology Study
'JMIR Publications Inc.', 2021Co-Authors: Faris F Brkic, Gerold Besser, Martin Schally, Elisabeth M Schmid, Thomas Parzefall, Dominik Riss, David T LiuAbstract:BackgroundThe data retrieved with the online sEarch engine, Google Trends, can summarize internet inquiries into specified sEarch terms. This engine may be used for analyzing inquiry peaks for different medical conditions and symptoms. ObjectiveThe aim of this study was to analyze World Wide Web interest peaks for “Ear pain,” “Ear infection,” and “Ear Drops.” MethodsWe used Google Trends to assess the public online interest for sEarch terms “Ear pain,” “Ear infection,” and “Ear Drops” in 5 English and non–English-speaking countries from both hemispheres based on time series data. We performed our analysis for the time frame between January 1, 2004, and December 31, 2019. First, we assessed whether our sEarch terms were most relevant to the topics of Ear pain, Ear infection, and Ear Drops. We then tested the reliability of Google Trends time series data using the intraclass correlation coefficient. In a second step, we computed univariate time series plots to depict peaks in web-based interest. In the last step, we used the cosinor analysis to test the statistical significance of seasonal interest peaks. ResultsIn the first part of the study, it was revealed that “Ear infection,” “Ear pain,” and “Ear Drops” were the most relevant sEarch terms in the noted time frame. Next, the intraclass correlation analysis showed a moderate to excellent reliability for all 5 countries’ 3 primary sEarch terms. The subsequent analysis revealed winter interest peaks for “Ear infection” and “Ear pain”. On the other hand, the World Wide Web sEarch for “Ear Drops” peaked annually during the summer months. All peaks were statistically significant as revealed by the cosinor model (all P values
