Histopathological and Inflammatory Features of Chronically Discharging Open Mastoid Cavities: Secondary Analysis of a Randomized Clinical Trial

Ceftazidime Poloxamer Gel: Expanding the Therapeutic Armamentarium for Ciprofloxacin-Resistant Pseudomonas Mastoid Cavity Otorrhea

OBJECTIVE

To present and evaluate the treatment of ciprofloxacin-resistant Pseudomonas mastoid cavity otorrhea with a ceftazidime thermosensitive poloxamer gel.

STUDY DESIGN

A retrospective clinical capsule report.

PATIENTS

Three patients diagnosed with ciprofloxacin-resistant Pseudomonas otorrhea in the setting of a previous canal-wall-down mastoidectomy between March 2019 and June 2023 visiting our tertiary care institution were retrospectively reviewed.

INTERVENTION

Application of a 2% ceftazidime thermosensitive poloxamer gel to mastoid cavity.

MAIN OUTCOME MEASURES

No evidence of disease during microscopic inspection of the ear within a month of initial treatment or bacterial eradication on subsequent culture.

RESULTS

Two patients had complete resolution of symptoms and achieved a safe and dry ear after topical application of the hydrogel. The second patient had pseudomonal eradication on culture, but persistent otorrhea due to other multidrug-resistant bacteria and an anatomically unfavorable mastoid cavity, which ultimately resolved after revision surgery.

CONCLUSIONS

This small case series suggests that topical treatment of mastoid cavity otorrhea with a 2% ceftazidime poloxomer gel is a potential therapeutic avenue in patients with ciprofloxacin-resistant Pseudomonas .

The effect of fascia and free skin graft on the healing of mastoid cavity after canal wall down mastoidectomy

OBJECTIVE

Post-mastoidectomy delayed cavity healing is a challenge to manage. This study aimed to cut down healing time with a simple technique (fascia with a skin graft) and compared it with controls without this technique.

METHOD

The current study was a prospective non-randomised controlled study, conducted in a tertiary referral hospital. Thirty cases and 30 controls with squamosal type chronic otitis media were studied.

RESULTS

By the end of first month, 23.3 per cent of cases had healed compared with 3.3 per cent of controls. At the third month follow up, 83.3 per cent of cases and 53.3 per cent of controls had healed. At the sixth month follow up, 93.3 per cent of cases and 86 per cent of controls had healed.

CONCLUSION

Healing of the mastoid cavity, as evidenced by epithelialisation and formation of a dry cavity, was faster in cases that received the graft when compared with controls without the graft.