1
|
Vijay A, Dirain CO, Chen S, Haberman R, Sharma A, Chiang YH, Antonelli PJ. Microbiome and Otic Quinolone Levels Following Tympanoplasty Assessed by Gelatin Sponge Analysis. Otolaryngol Head Neck Surg 2024; 171:400-407. [PMID: 38529675 DOI: 10.1002/ohn.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To determine if absorbable gelatin sponge (AGS) can be used to assess the posttympanoplasty microbiome and otic antibiotic exposure. STUDY DESIGN Prospective. SETTING Tertiary hospital. METHODS Patients undergoing tympanoplasty were prospectively enrolled. Intraoperatively, AGS was applied to the medial ear canal/tympanic membrane (TM) for 1 minute after canal incision, then saved for analysis. Ear canals were packed with AGS at the end of surgery. Otic ofloxacin was administered until the first postoperative visit, when AGS was collected. Microbial presence was assessed by culture. Ofloxacin levels were assessed by liquid-chromatography mass-spectrometry. RESULTS Fifty-three patients were included. AGS was collected in 92.9% of patients seen within 21 days compared to 70.8% of those seen at 22 to 35 days. At surgery, AGS yielded bacteria and fungi in 81% and 11%, respectively, including Staphylococcus species (55%) and Pseudomonas species (25%). Postoperatively, AGS yielded bacteria in 71% and fungi in 21% at the meatus, (staphylococci 57% and pseudomonas 25%). TM samples yielded bacteria in 69%, fungi in 6%, staphylococci in 53%, and pseudomonas in 19%. Ofloxacin concentration at the meatus was 248 μg/mL (95% confidence interval [CI]: 119-377) and at the TM was 126 μg/mL (95% CI: 58-194). Ofloxacin-resistant colonies were found in 75% of patients. CONCLUSION Analysis of AGS is a viable technique for noninvasively studying healing metrics posttympanoplasty, including the microbiome and otic antibiotic exposure. Despite exposure to a high concentration of quinolones, the tympanoplasty wound is far from sterile, which may impact healing outcomes.
Collapse
Affiliation(s)
- Arunima Vijay
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Carolyn O Dirain
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Si Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Rex Haberman
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Abhisheak Sharma
- Department of Pharmaceutics, University of Florida, Gainesville, Florida, USA
| | - Yi-Hua Chiang
- Department of Pharmaceutics, University of Florida, Gainesville, Florida, USA
| | - Patrick J Antonelli
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Zeng H, Yang Y, Gao J, Zhou Y, Zheng J. Study of the impurity profile of photodegradation in lomefloxacin hydrochloride ear drops using liquid chromatography combined with ion trap/time-of-flight mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2024; 38:e9732. [PMID: 38525499 DOI: 10.1002/rcm.9732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/17/2024] [Accepted: 02/17/2024] [Indexed: 03/26/2024]
Abstract
RATIONALE Lomefloxacin hydrochloride ear drops are highly unstable to light and prone to produce photodegradation impurities. These impurities might be related to the phototoxicity of lomefloxacin, which could seriously threaten the health of patients. In this article, the photodegradation impurity profile in lomefloxacin hydrochloride ear drops was studied for further improvement of quality control of the drug. METHODS By studying the chromatographic behavior of photodegradation impurities, the photodegradation impurities in lomefloxacin hydrochloride ear drops were separated and detected effectively. Liquid chromatography combined with ion trap/time-of-flight mass spectrometry was applied to characterize the structures of the photodegradation impurities in lomefloxacin hydrochloride ear drops. RESULTS The structures of 17 impurities in lomefloxacin hydrochloride ear drops were elucidated based on high-resolution MSn data in positive ion mode, 12 of them being unknown impurities. CONCLUSIONS The structural characteristics and fragmentation patterns of the photodegradation impurities were also studied. The study of the photodegradation impurity profile in lomefloxacin hydrochloride ear drops provides a scientific basis for quality control of these ear drops and ensures the safety of drug use by the public.
Collapse
Affiliation(s)
- Hongxia Zeng
- Key Laboratory for Core Technology of Generic Drug Evaluation National Medical Product Administration & Key Laboratory of Drug Contacting Materials Quality Control of Zhejiang Province, Zhejiang Institute for Food and Drug Control, Hangzhou, China
| | - Ying Yang
- China Jiliang University, Hangzhou, China
| | - Jiarui Gao
- Zhejiang University of Technology, Hangzhou, China
| | - Yuping Zhou
- Zhejiang University of Technology, Hangzhou, China
| | - Jinqi Zheng
- Key Laboratory for Core Technology of Generic Drug Evaluation National Medical Product Administration & Key Laboratory of Drug Contacting Materials Quality Control of Zhejiang Province, Zhejiang Institute for Food and Drug Control, Hangzhou, China
| |
Collapse
|
3
|
Kolb CL, Dirain CO, Antonelli PJ. Tympanoplasty Healing Outcomes With Use of Postoperative Otic Quinolones. Otol Neurotol 2023; Publish Ahead of Print:00129492-990000000-00316. [PMID: 37367633 DOI: 10.1097/mao.0000000000003919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Tympanoplasty usually results in tympanic membrane perforation (TMP) closure, but healing may be suboptimal (e.g., excess scarring). Factors that have been linked to impaired TM healing have become widely adopted (especially, postoperative use of quinolone ear drops). The aim of this study is to assess the frequency of suboptimal tympanoplasty healing with the use of otic quinolones postoperatively. STUDY DESIGN Retrospective chart review. SETTING Tertiary care facility. PATIENTS One hundred patients undergoing tympanoplasty for TMP. INTERVENTIONS Tympanoplasty +/- canalplasty. MAIN OUTCOME MEASURES Healing complications (e.g., granulation tissue, TMP, myringitis, bone exposure, lateralization, anterior blunting, medial canal fibrosis, and canal stenosis) and hearing loss. METHODS Charts were reviewed for postoperative healing issues and hearing outcomes at 1 to 2 years postoperatively. RESULTS TMP closure was found in 93.2%, but 34.2% had healing issues at 1 to 2 years postoperatively, with 20.6% having adverse healing outcomes (perforation (6.9%), granulation tissue (6.9%), medial fibrosis (4.1%), and myringitis, bone exposure, and webbing (all 1.4%). Another 13.7% had notable postoperative issues, such as protracted otorrhea (11.0%), otitis externa (9.6%), otitis media (1.4%), and atelectasis (2.7%). No medical, surgical, or patient factors impacted outcomes. Average air-bone gap at 1 to 2 years did not differ between patients with and without healing issues and patients with other postoperative issues (p = 0.5). CONCLUSIONS Suboptimal healing is common after tympanoplasty. There may be significant opportunity to improve post-tympanoplasty healing beyond improving the TMP closure rate.
Collapse
Affiliation(s)
- Casey L Kolb
- University of Florida Department of Otolaryngology, Gainesville, Florida
| | | | | |
Collapse
|
4
|
Xu B, Gao J, Zhu B, Li P, Su W, Wang J. Study on the impurity profile and influencing factors of photodegradation in non-aqueous ofloxacin ear drops using liquid chromatography combined with ion trap/time-of-flight mass spectrometry. J Pharm Biomed Anal 2023; 233:115476. [PMID: 37245330 DOI: 10.1016/j.jpba.2023.115476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
Ofloxacin ear drops contain a large proportion of organic solvents, which have a great effect on the photodegradation of ofloxacin. The photodegradation impurities of ofloxacin in aqueous solution has been studied, however, the photodegradation of ofloxacin in non-aqueous solution with a high proportion of organic solvents has not been reported. In this article, the impurity profile in non-aqueous ofloxacin ear drops was studied for further improvement of official monograph in pharmacopoeia and quality control of drug. The liquid chromatography combined with ion trap/time-of-flight mass spectrometry was applied to separate and characterize the structures of the impurities in non-aqueous ofloxacin ear drops. Mass fragmentation pattern of ofloxacin and its impurities were studied. The structures of seventeen impurities in ofloxacin ear drops were elucidated based on the high-resolution MSn data in positive ion modes, and ten of them were unknown impurities. The results showed that the impurity profile of non-aqueous ofloxacin solution was significantly different from that of aqueous ofloxacin solution. The effects of packaging materials and excipients on the photodegradation of ofloxacin ear drops were also investigated. The results of correlation analysis showed that the packaging materials with low light transmittance could reduce the light degradation, and ethanol of excipients could significantly decrease the light stability of ofloxacin ear drops. This study revealed the impurity profile and key factors affecting the photodegradation of non-aqueous ofloxacin ear drops, and guided enterprises to improve drug prescription and packaging materials to ensure the safety of drug use by the public.
Collapse
Affiliation(s)
- Bingyong Xu
- Zhejiang University of Technology, Hangzhou 310014, China
| | - Jiarui Gao
- Zhejiang University of Technology, Hangzhou 310014, China
| | - Bingqi Zhu
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ping Li
- Zhejiang University of Technology, Hangzhou 310014, China
| | - Weike Su
- Zhejiang University of Technology, Hangzhou 310014, China.
| | - Jian Wang
- Zhejiang University of Technology, Hangzhou 310014, China; Zhejiang Institute for Food and Drug Control, Key Laboratory for Core Technology of Generic Drug Evaluation National Medical Product Administration & Key Laboratory of Drug Contacting Materials Quality Control of Zhejiang Province, Hangzhou 310052, China.
| |
Collapse
|
5
|
Li H, Roy CF, Cerruti M, Yeung JC. Structural Integrity of Absorbable Gelatin Sponges for Middle Ear Packing in Otologic Surgery. Otol Neurotol 2023; 44:e350-e355. [PMID: 36962059 DOI: 10.1097/mao.0000000000003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
OBJECTIVE This study investigates the physical properties upon immersion of two gelatin sponges commonly used in otologic surgery. BACKGROUND Absorbable gelatin sponges are often used in middle ear surgery to achieve hemostasis and, perhaps more importantly, to provide a "scaffolding" to support ossicular chain and/or tympanic membrane reconstructions. Their rate of dissolution may therefore affect the success of tympanic membrane closure. METHODS An in vitro study was conducted to quantify the material changes of two absorbable gelatin sponges, a standard-density sponge and one with fewer collagen cross-linkages (low-density sponge). Volume loss (%) in 0.9% saline, 0.3% ciprofloxacin, and/or 0.1% dexamethasone as single-agent otic drops in a combination formulation was measured at 15-minute intervals for the first hour and at days 1, 3, and 5 postimmersion. Secondary end points included compressibility, porosity under microscopy, and infrared spectroscopy analysis. RESULTS The low-density sponge immersed in any of the three otic solutions showed a statistically significant greater volume loss at all time points when compared with the standard-density sponge (27.2% ± 5.4% vs. 15.4% ± 6.0% at 15 minutes and 44.8% ± 5.1% vs. 34.6% ± 2.9% at 5 days, p < 0.001). Interestingly, both sponges immersed in normal saline had lost almost half of their original volume after 15 minutes when compared with samples immersed in an otic solution (48.3% ± 4.6% vs. 21.3% ± 8.3%, respectively, p < 0.001). CONCLUSION The standard-density sponge immersed in an otic solution of ciprofloxacin, dexamethasone, or a combination formulation best maintained its structural integrity. Ancillary in vivo studies are required to assess the hemostatic properties, surgical outcomes, and middle ear synechiae of the above study conditions. LEVEL OF EVIDENCE Foundational evidence.
Collapse
Affiliation(s)
- Hao Li
- Department of Materials Engineering, McGill University, 3610 Rue University, Montréal, QC H3A 0C5, Canada
| | - Catherine F Roy
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Marta Cerruti
- Department of Materials Engineering, McGill University, 3610 Rue University, Montréal, QC H3A 0C5, Canada
| | - Jeffrey C Yeung
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|
6
|
Tran PT, Antonelli PJ, Winterstein AG. Quinolone Ear Drops and Achilles Tendon Rupture. Clin Infect Dis 2023; 76:e1360-e1368. [PMID: 36065683 DOI: 10.1093/cid/ciac709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delayed eardrum healing has been observed in the ear opposite to the ear treated with otic quinolones (OQ) in rats. Case reports describe tendinopathies after OQ treatment, suggesting adverse systemic effects. METHODS We studied patients aged 19 to 64 years with diagnosis of otitis externa or media in private insurance between 2005 and 2015. We compared OQ treatment against otic neomycin, oral amoxicillin, or azithromycin. Outcomes included Achilles tendon rupture (ATR), Achilles tendinitis (AT), and all-type tendon rupture (ATTR). We applied an active comparator, new-user design with 1-year look-back and ceased follow-up at initiation of systemic steroids or oral quinolones, external injury, hospitalization, and after 35 days. We used trimmed stabilized inverse probability of treatment weights to balance comparison groups in a survival framework. Negative outcomes (clavicle fractures or sports injuries) were examined to rule out differences from varied physical activity (unmeasured confounding). RESULTS We examined 1 501 009 treated otitis episodes. Hazard ratios (HR) for OQ exposure associated with ATR were 4.49 (95% confidence interval [CI], 1.83-11.02), AT 1.04 (95% CI, 0.73-1.50), and ATTR 1.71 (95% CI, 1.21-2.41). Weighted risk differences (RD) per 100 000 episodes for OQ exposure were ATR 7.80 (95% CI, 0.72-14.89), AT 1.01 (95% CI, -12.80 to 14.81), and ATTR 18.57 (95% CI, 3.60-33.53). Corresponding HRs for clavicle fractures and sports injuries were HR,1.71 (95% CI, 0.55-5.27) and HR,1.45 (95% CI, 0.64-3.30), suggesting limited residual confounding. CONCLUSIONS OQ exposure may lead to systemic consequences. Clinicians should consider this potential risk and counsel patients accordingly. Risk factors and mechanisms for this rare, adverse effect deserve further evaluation. Mechanistic and other clinical studies are warranted to corroborate this finding.
Collapse
Affiliation(s)
- Phuong T Tran
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Faculty of Pharmacy, HUTECH University, Ho Chi Minh City, Vietnam
| | - Patrick J Antonelli
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
7
|
Bove C, Baldock RA, Champigneulle O, Martin L, Bennett CL. Fluoroquinolones - Old drugs, putative new toxicities. Expert Opin Drug Saf 2022; 21:1365-1378. [DOI: 10.1080/14740338.2022.2147924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cecilia Bove
- Department of Biological Sciences, York College of Pennsylvania, 441 Country Club Road, York, PA, USA
| | - Robert A. Baldock
- School of Pharmacy and Biomedical Science, University of Portsmouth, St. Michael’s Building, White Swan Road, Portsmouth, PO1 2DT, UK
| | - Oscar Champigneulle
- University of South Carolina Schools of Pharmacy and Engineering and the SmartState Center for Medication Safety and Efficacy, Columbia, SC, USA
| | - Linda Martin
- University of South Carolina Schools of Pharmacy and Engineering and the SmartState Center for Medication Safety and Efficacy, Columbia, SC, USA
| | - Charles L Bennett
- University of South Carolina Schools of Pharmacy and Engineering and the SmartState Center for Medication Safety and Efficacy, Columbia, SC, USA
- Beckman Research Institute (BRI) of City of Hope and the Department of Comparative Medicine and Evidence Based Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| |
Collapse
|
8
|
Li S, Chen Z, Huang L, Liu Z, Shi Y, Zhang M, Li H, Zeng L, Ni J, Zhu Y, Jia ZJ, Cheng G, Zhang L. Safety of Quinolones in Children: A Systematic Review and Meta-Analysis. Paediatr Drugs 2022; 24:447-464. [PMID: 35771411 DOI: 10.1007/s40272-022-00513-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The results of animal experiments show that quinolone antibacterial drugs may permanently damage the soft tissues of the weight-bearing joints of young animals. Out of safety concerns, using quinolones in children has always been controversial. OBJECTIVE The aim of this study was to assess the risk of using quinolones in children and provide evidence for clinicians to support decision making. DATA SOURCES The MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), International Pharmaceutical Abstracts (Ovid), CINAHL, CNKI, VIP, and WanFang Data databases were searched from inception to 8 September 2021. STUDY SELECTION All types of studies that reported the safety data of quinolones in children, including clinical trials and observational studies. DATA EXTRACTION Data extraction and cross-checking were completed by two independent reviewers using a pilot-tested standardized data extraction form. RESULTS The overall incidence rate of adverse drug events (ADEs) in children using systemic quinolones was 5.39% and the most common ADEs were gastrointestinal reactions (incidence rate, 2.02%). Quinolone-induced musculoskeletal ADEs in children were uncommon (0.76%). Meta-analysis results showed that the risk of musculoskeletal ADEs in children using quinolones was higher than children in the control group (51 studies; rate ratio [RR] 2.03, 95% confidence interval [CI] 1.82-2.26; p < 0.001; I2 = 18.6%; moderate-quality evidence). However, the subgroup analysis results showed that differences might only be observed in children who were followed up for 2 months to 1 year (2-6 months: RR 2.56, 95% CI 2.26-2.89; 7 months to 1 year: RR 1.35, 95% CI 0.98-1.86). Moreover, children (adolescents) aged between 13 and 18 years might be sensitive to the musculoskeletal toxicity of quinolones (RR 2.69, 95% CI 2.37-3.05; moderate-quality evidence) and the risk of levofloxacin-induced musculoskeletal ADEs might be higher (RR 1.33, 95% CI 1.00-1.77; low-quality evidence). CONCLUSIONS Although the existing evidence shows that quinolone-induced musculoskeletal ADEs seem to be only short-term and reversible, and no serious skeletal and muscular system damage cases have been reported in children, quinolones should be avoided unless necessary in children because the incidence rate of quinolone-related ADEs is not low and they are broad-spectrum antibiotics that will induce the emergence of resistant strains if used frequently.
Collapse
Affiliation(s)
- Siyu Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.,West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China
| | - Liang Huang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China
| | - Zheng Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.,West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Yuqing Shi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.,West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.,West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China
| | - Jiaqi Ni
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Yu Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.,West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.,Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, 610041, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, 610041, China. .,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, 610041, China.
| |
Collapse
|
9
|
Wang LC, Phyland D, Giddings CE. A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2). Clin Otolaryngol 2021; 47:287-294. [PMID: 34758186 DOI: 10.1111/coa.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effectiveness of ciprofloxacin 0.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. DESIGN 3-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5-day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. SETTING The study was conducted in a large tertiary health network in Melbourne, Australia. PARTICIPANTS All children, 17 years and under, undergoing bilateral MEVT surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. MAIN OUTCOME MEASURES Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. RESULTS 256 paediatric patients completed the study with a median age of 4.02 years. 153 participants were male. By ear-analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=0.341, 95%CI 0.158-0.738, NNT= 11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=0.424, 95%CI 0.193 to 0.930, NNT=14.7 p=.032). CONCLUSION Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.
Collapse
Affiliation(s)
- Luke Chenkan Wang
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Debra Phyland
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Charles Edward Giddings
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| |
Collapse
|
10
|
Winterstein AG, Antonelli PJ. Triangulation of pharmacoepidemiology and laboratory science to tackle otic quinolone safety. Basic Clin Pharmacol Toxicol 2021; 130 Suppl 1:75-80. [PMID: 34611995 PMCID: PMC9298360 DOI: 10.1111/bcpt.13668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 12/05/2022]
Abstract
Background The scientific method requires studies with high internal and external validity. Though both are necessary, they do not go hand‐in‐hand: The more controlled a study is to enhance internal validity, the less applicable to real‐world clinical care, and vice versa. In the many instances where evidence from clinical trials is not available, scientific inference must rely on more extreme approaches on this spectrum, such as mechanistic (limited generalizability/strong bias control) and real‐world evidence (RWE) studies (higher generalizability/lesser bias control). Objectives Illustrate how triangulating mechanistic and RWE studies can enhance scientific inference by delivering the supporting evidence for both. Methods We describe our research on an unexpected and highly unlikely drug safety issue: the risk of tympanic membrane (TM) perforations resulting from otic quinolone therapy. Tightly controlled laboratory studies using cell culture and rodent models were complemented with pharmacoepidemiological studies of real‐world data to translate mechanistic findings and corroborate RWE. Results We present a cascade of mechanistic and RWE studies investigating fibroblast cytotoxicity, delayed healing of perforated TMs, and spontaneous TM perforations after otic quinolone exposure, all suggesting local tissue toxicity. Conclusion Triangulation of mechanistic and RWE studies allowed incremental progress toward robust evidence on otic quinolone toxicity.
Collapse
Affiliation(s)
- Almut G Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA.,Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Patrick J Antonelli
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA.,Otolaryngology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
11
|
Faramarzi M, Kazemi T, Shishegar M, Zargerani O, Faramarzi A, Mohammadi T, Kooreshnia F, Aghaei S, Asadi M, Babaei A. Does intraoperative ciprofloxacin-soaked gelfoam have adverse effects on graft success rate? A randomized, double-blind controlled trial. Laryngoscope Investig Otolaryngol 2021; 6:1182-1187. [PMID: 34667864 PMCID: PMC8513452 DOI: 10.1002/lio2.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate whether intraoperative ciprofloxacin-soaked gelfoam is safe in tympanoplasty or not. METHOD In this randomized, double-blind controlled clinical study, we included 100 patients between 18 and 60 years old, having perforation ≥50% of the tympanic membrane and dry ear for at least 2 months who were a candidate for underlay tympanoplasty via postauricular approach. We used ciprofloxacin soaked gelfoam in the case group and betamethasone soaked gelfoam in the control group for packing the middle ear cavity and external auditory canal during their operation. The graft success rate and tympanogram after 6 months follow-up period was considered as the primary outcome. Also, we evaluated the postoperative hearing results 6 months after the surgery as the secondary outcomes. RESULTS Postoperative microscopic otoscopy showed a graft success rate of 100% (44/44) and 97.7% (42/43) in the case and control groups, respectively. The level of improvement between the two groups was not significant for air-bone gap (ciprofloxacin: 9.01 ± 7.89 dB, betamethasone 5.31 ± 10.53 dB, P = .160), and speech reception thresholds (SRT; ciprofloxacin: 10.23 ± 8.62 dB, betamethasone 7.33 ± 12.60 dB, P = .260). 93.2% of all the ears in the case group and 81.4% of those in the control group achieved postoperative air-bone gap within 20 dB, but the difference between them was not significant (P = .118). CONCLUSIONS We found that the application of ciprofloxacin impregnated gelfoam in the middle ear, and the external auditory canal had no adverse effect on the graft success rate in tympanoplasty. LEVELS OF EVIDENCE 1b.
Collapse
Affiliation(s)
- Mohammad Faramarzi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Tayebeh Kazemi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Mahmoud Shishegar
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Omid Zargerani
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Ali Faramarzi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Tahereh Mohammadi
- Department of Communication Sciences and DisordersNorthwestern UniversityChicagoIllinoisUSA
| | - Fatemeh Kooreshnia
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Saleh Aghaei
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohammadali Asadi
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Amirhossein Babaei
- Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| |
Collapse
|
12
|
The Influence of Ciprofloxacin-Dexamethasone Ear Drops on Perforation Closure Rates After Endoscopic Tympanoplasty. Otol Neurotol 2021; 42:e1644-e1647. [PMID: 34172656 DOI: 10.1097/mao.0000000000003236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Topical ciprofloxacin and dexamethasone have both been shown to disrupt healing of tympanic membrane perforations in animal models. There have been no clinical studies evaluating the effect of ciprofloxacin-dexamethasone (CD) ear drops on success of tympanoplasty. We compare perforation closure rates in pediatric endoscopic tympanoplasty with and without use of postoperative CD. STUDY DESIGN Retrospective comparative cohort study. SETTING Tertiary referral centre. PATIENTS One hundred sixty-two totally endoscopic tympanoplasties with porcine-derived collagen graft in children, mean age 12.0 years (range 2.3-17.9 yrs). INTERVENTION Prescription of CD versus no ear drops in the immediate postoperative period. MAIN OUTCOME MEASURE Perforation closure rate 2 months after totally endoscopic tympanoplasty. RESULTS Postoperative CD was given to 65 (40%) ears and no drops given to the remainder. Overall, successful closure of tympanic membrane perforation was achieved in 140 (86%) of ears. The closure rate was not significantly different in those ears given CD postoperatively than those not given CD (54/65 [83%] vs 86/97 [89%], Fisher's p = 0.35). Multiple logistical regression revealed no confounding effect of other variables on outcome including age, revision surgery, graft position, or type of postoperative packing material. CONCLUSIONS Our results reveal no harm or benefit with prescription of drops containing ciprofloxacin and dexamethasone on success of perforation closure after tympanoplasty. Allocation to treatment in this retrospective study was nonrandomized and was predominantly based on a change in practice. No other variables are known to have influenced this finding but a randomized prospective study could be justified for more reliable evidence.
Collapse
|
13
|
Simani L, Oron Y, Handzel O, Eta RA, Warshavsky A, Horowitz G, Muhanna N, Ungar OJ. Paper Patching Versus Watchful Waiting of Traumatic Tympanic Membrane Perforations: A Meta-Analysis. Laryngoscope 2021; 131:2091-2097. [PMID: 33881175 DOI: 10.1002/lary.29580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs). STUDY DESIGN Systematic review with meta analysis. METHODS Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta-analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed. RESULTS Five studies describing 393 TTMPs were included in the quantitative meta-analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04-1.21). CONCLUSIONS TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone. LEVEL OF EVIDENCE NA Laryngoscope, 131:2091-2097, 2021.
Collapse
Affiliation(s)
- Liam Simani
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rani Abu Eta
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anton Warshavsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer J Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
14
|
Wang LC, Giddings CE, Phyland D. Predictors of postoperative complications in paediatric patients receiving grommets - A retrospective analysis. Int J Pediatr Otorhinolaryngol 2021; 142:110601. [PMID: 33412341 DOI: 10.1016/j.ijporl.2020.110601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Insertion of middle ear ventilation tubes (MEVT), tympanostomy tubes or grommets is one of the most common paediatric surgical procedures performed by ENT surgeons worldwide. Outcomes may be complicated by postoperative otorrhoea and ventilation tube blockage. OBJECTIVE To identify risk factors associated with early postoperative complications of MEVT insertion. METHOD In a case-control study, set in a tertiary hospital in Melbourne, Australia, 590 paediatric patients undergoing grommet insertion between February 2017 and February 2018, 311 patients (205 males & 106 females; median age of 3.86 years) met the inclusion criteria and had identical middle ear status bilaterally. INTERVENTION Tympanostomy tube insertion and postoperative topical otic antibiotic drops. MAIN OUTCOME AND MEASURES Patient age, gender, weight/BMI percentile, intraoperative middle ear status, number of previous grommets, type of surgery, season of surgery, diagnosis and time to first medical review were examined. The duration of topical otic antibiotic drops used and tube patency and presence of otorrhoea at 6-week postoperative review were also recorded. RESULTS At the first medical review, 8.7% of patients (n = 27) developed otorrhoea from one or both ears, 6.4% of patients (n = 20) had an obstructed MEVT in one or both ears. Exposure to intraoperative [IO] and postoperative [PO] antibiotic drops were significantly less associated with developing postoperative otorrhoea compared to non-exposure (IO: Odds Ratio [OR] = 0.15, 95%CI 0.04 to 0.57, p = 0.005; PO: OR = 0.21, 95%CI 0.58 to 0.76, p = 0.017). There were no statistically significant associations between antibiotic drop exposure and grommet blockage (p > 0.05). There was a significant association between developing postoperative otorrhoea and patients receiving surgery during the colder months of Winter/Autumn (OR = 3.17, 95%CI 1.14 to 8.84, p = 0.028), as well as patients aged less than 3 years (OR = 2.66, 95%CI 1.01 to 7.03, p = 0.049). There was a statistically significant association between serous effusions and grommet blockage compared to no effusion (OR = 4.03, 95%CI 1.03 to 15.7, p = 0.045). There were no statistically significant associations identified between otorrhoea and gender, weight/BMI percentile, intraoperative middle ear status, number of previous grommets, type of surgery, diagnosis and time to first medical review. There were no statistically significant associations between grommet blockage and age, gender, indication for surgery, concurrent surgery, season or number of previous grommets. CONCLUSIONS 8.7% of patients developed otorrhoea within 6 weeks post-operatively. Undergoing the procedure during winter/autumn, age <3 years were associated with developing otorrhoea. Topical antibiotic exposure was inversely associated with developing postoperative otorrhoea. 6.4% of patients had grommet blockage. Presence of serous middle ear effusion intraoperatively was a statistically significant indicator for developing grommet blockage.
Collapse
Affiliation(s)
- Luke Chenkan Wang
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Otolaryngology-Head and Neck Surgery, Monash Health, Melbourne, Australia.
| | - Charles Edward Giddings
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Otolaryngology-Head and Neck Surgery, Monash Health, Melbourne, Australia
| | - Debra Phyland
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Otolaryngology-Head and Neck Surgery, Monash Health, Melbourne, Australia
| |
Collapse
|
15
|
Khanal P, Guragain RP, Bhusal CL. Comparison of postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2020; 131:109893. [PMID: 31981921 DOI: 10.1016/j.ijporl.2020.109893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty. METHODS This is a prospective, randomized controlled study conducted in children of age 6-15 years with chronic otitis media (COM) mucosal, inactive type undergoing myringoplasty. Postoperative infection over a period of 4 weeks and status of graft at or around 3 months after surgery was studied as outcome measure. RESULTS Fifty five out of sixty children completed follow-up. The overall postoperative infection rate was 5.4%. Postoperative infection rate was 3.5% in children receiving prophylactic antibiotic and 7.4% in children receiving no antibiotic. There was no statistically significant difference in postoperative infection between two groups (P > 0.05). The overall graft uptake rate was 87.27%. It was 85.7% in antibiotic used group and 88.8% in non-antibiotic group with no statistically significant difference (P > 0.05). CONCLUSIONS Postoperative infection following myringoplasty in children is uncommon as it is a clean type of surgery. There was no statistically significant difference in postoperative infection and graft uptake rate by the use of prophylactic antibiotic in the intraoperative period. This study shows no benefit of a prophylactic antibiotic on postoperative infection or graft success in myringoplasty in children. TRIAL REGISTRATION NUMBER NCT03700814.
Collapse
Affiliation(s)
| | | | - Chop Lal Bhusal
- Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal
| |
Collapse
|
16
|
Karnani DN, Dirain CO, Antonelli PJ. The Effects of Steroids on Survival of Mouse and Human Tympanic Membrane Fibroblasts. Otolaryngol Head Neck Surg 2020; 163:382-388. [PMID: 32204660 DOI: 10.1177/0194599820912739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Tympanic membrane (TM) fibroblast cytotoxicity of quinolone ear drops is enhanced by dexamethasone and fluocinolone. Hydrocortisone has not been evaluated. We aimed to assess the effects of these 3 steroids on mouse and human TM fibroblast survival. STUDY DESIGN In vitro. SETTING Academic laboratory. SUBJECTS AND METHODS Mouse and human TM fibroblasts were exposed to hydrocortisone, dexamethasone, or fluocinolone at concentrations in commercial ear drops (1%, 0.1%, or 0.025%, respectively) and at steroid potency equivalents (1%, 0.033%, or 0.0033%, respectively), or dilute ethanol (control), twice within 24 hours or 4 times within 48 hours for 2 hours each time. Cells were observed with phase-contrast microscopy until the cytotoxicity assay was performed. RESULTS Mouse and human TM fibroblasts treated with any of the steroids had lower survival after 24 and 48 hours compared to control (all P < .0001). After 24 hours, viability of mouse fibroblasts treated with the steroids was not different (P > .05), while treatment with hydrocortisone decreased human TM fibroblast viability (P < .0001). After 48 hours, at concentrations found in ear drops and at equivalent steroid potency, dexamethasone and fluocinolone had similar survival in mouse and human fibroblasts (all P > .05), but hydrocortisone had lower survival in both mouse (P = .02 and P < .0001) and human (P < .0001) fibroblasts. Phase-contrast images mirrored the cytotoxicity findings. CONCLUSION Steroids found in commercial ear drops reduce survival of mouse and human TM fibroblasts. Hydrocortisone appears to be more cytotoxic than the more potent steroids, dexamethasone and fluocinolone. These findings should be considered when assessing clinical outcomes of ototopical preparations.
Collapse
Affiliation(s)
- David N Karnani
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carolyn O Dirain
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick J Antonelli
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
17
|
Brown C, Behar P. Factors affecting persistent tympanic membrane perforation after tympanostomy tube removal in children. Int J Pediatr Otorhinolaryngol 2020; 130:109779. [PMID: 31786523 DOI: 10.1016/j.ijporl.2019.109779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Evaluate and compare the rates of persistent tympanic membrane (TM) perforations between short-term vs long-term tympanostomy tubes. In addition, to determine which demographic, anatomical, and physical factors affect ear drum healing after tympanostomy tube (TT) removal and simultaneous paper patch myringoplasty (PPM) in children. STUDY DESIGN Retrospective chart review. METHODS Charts were reviewed from the Women and Children's of Buffalo hospital and our pediatric otolaryngology practice electronic medical record. Data was retrieved from patients less than 18 years old who underwent surgical removal of a TT and concomitant PPM between January 2005 and January 2017. RESULTS 343 ear drums were studied that underwent tympanostomy tube removal and paper patch myringoplasty. 45/343 (13%) of ears had a persistent perforation after PPM. The rate of persistent perforation with short-term tubes and long-term tubes was significantly different (6.6% and 20% respectively). Patient characteristics significantly associated with persistent perforations were: age at time of tube removal and number of tubes that patient received. Ear drum characteristics that significantly impacted persistent perforation included: size of ear drum perforation, and presence of tympanosclerosis. Length of intubation, ear drum atrophy, retraction, granulation tissue, middle ear effusion and thickened ear drum were not found to be significant factors. CONCLUSION Overall, we found an 87% perforation closure rate after surgical removal of the TT and PPM. Persistent perforations occurred significantly more often in patients with long-term tubes than short term tubes. Our data also suggests that several patient and ear drum characteristics may be important factors that contribute to persistent perforation after tympanostomy tube placement and removal.
Collapse
Affiliation(s)
- Clarice Brown
- UTSW Medical Center, Department of Otolaryngology, F6.221, 2350 N. Stemmons Freeway, Dallas, 75207, Texas, USA.
| | - Philomena Behar
- Pediatric ENT Associates, PLLC 3580 Sheridan Drive Ste. 120, Amherst, 14226, NY, USA.
| |
Collapse
|
18
|
Dirain CO, Karnani DN, Antonelli PJ. Cytotoxicity of Ear Drop Excipients in Human and Mouse Tympanic Membrane Fibroblasts. Otolaryngol Head Neck Surg 2019; 162:204-210. [DOI: 10.1177/0194599819889701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Commercial ear drops contain ingredients reported to be inactive. We sought to evaluate such excipients for possible cytotoxicity on human and mouse tympanic membrane (TM) fibroblasts. Study Design Prospective, in vitro. Setting Tertiary academic center. Subjects and Methods Mouse and human TM fibroblasts were treated with 1:10 dilutions of benzalkonium chloride (BKC) 0.0025%, 0.006%, or 0.01%; benzyl alcohol 0.9%; polysorbate 80 (PSB) 2.5%; glycerin 2.4%; povidone 0.2%; or water (control), twice within 24 hours or 4 times within 48 hours, for 2 hours each time. Cells were placed back in growth media after the treatments. Cells were observed with phase-contrast microscopy until the cytotoxicity assay was performed. Results Mouse fibroblasts had lower survival in only the PSB-treated cells compared to the control ( P < .0001) after 24 hours. After 48 hours, PSB killed nearly all mouse fibroblasts ( P < .0001). BKC decreased fibroblast survival in a dose-dependent manner ( P < .001). In human TM fibroblasts, all excipients except povidone and benzyl alcohol after 24 hours and povidone after 48 hours reduced cell survival compared to control ( P = .012 to P < .0001). The cytotoxicity of BKC in human TM fibroblasts was also dose dependent (<.0001). PSB was less cytotoxic to human fibroblasts. Phase-contrast images mirrored the cytotoxicity findings. Conclusion Polysorbate 80 and benzalkonium chloride, at concentrations found in commercial ear drops, may be cytotoxic to human and mouse TM fibroblasts. “Inactive” ingredients may need to be considered when evaluating clinical outcomes with commercial ear drops.
Collapse
Affiliation(s)
- Carolyn O. Dirain
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - David N. Karnani
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Antonelli
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
19
|
Commercial Quinolone Ear Drops Cause Perforations in Intact Rat Tympanic Membranes. Otol Neurotol 2019; 40:1386-1391. [DOI: 10.1097/mao.0000000000002371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
20
|
Alrwisan AA, Wei YJ, Brumback BA, Antonelli PJ, Winterstein AG. Concomitant Use of Quinolones and Stimulants and the Risk of Adverse Cardiovascular Symptoms: A Retrospective Cohort Study. Pharmacotherapy 2019; 39:1167-1178. [DOI: 10.1002/phar.2343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Adel A. Alrwisan
- Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida
- Saudi Food and Drug Authority Riyadh Saudi Arabia
| | | | | | | | - Almut G. Winterstein
- Saudi Food and Drug Authority Riyadh Saudi Arabia
- Department of Epidemiology College of Public Health and Health Professions and College of Medicine University of Florida Gainesville Florida
| |
Collapse
|
21
|
Tran PT, Winterstein AG, Wang X, Rhew K, Antonelli PJ. Appropriateness of Otic Quinolone Use among Privately Insured US Patients. Otolaryngol Head Neck Surg 2019; 162:102-107. [DOI: 10.1177/0194599819889607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective Considering emerging safety concerns involving otic quinolones, we assessed the extent of otic quinolone use for questionable indications. Study Design Descriptive cross-sectional study of a national sample of privately insured patients. Setting Outpatient encounters in the United States. Subjects and Methods Children and adults with outpatient pharmacy-dispensing claims for new prescriptions of otic or ophthalmic quinolones in 2017 were identified within the IBM MarketScan Commercial Claims & Encounters and the Medicare Supplemental Database. Each dispensing ≥30 days apart constituted a unique episode. Only claims with supporting ear-related diagnoses on outpatient encounters ±3 days of dispensing were considered. Ophthalmic drops were excluded if eye-related diagnoses were found ±30 days. Prescribing was classified as appropriate, questionable, or undetermined. Results We found 214,897 episodes in 200,270 patients. Adults were twice as likely as children to have otic treatment with questionable indications (6.2% vs 3.0%). Sensitivity analyses with broader time windows to ascertain diagnoses showed similar proportions of questionable use. Otalgia and cerumen impaction constituted 90% of questionable indications. Family physicians (6.8%) and internists (8.0%) had higher percentages of questionable use than other specialties. Conclusion Based on the demonstrated risks of quinolone ear drops, opportunities exist to decrease otic quinolone use, especially in adults.
Collapse
Affiliation(s)
- Phuong T. Tran
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Faculty of Pharmacy, Ho Chi Minh City University of Technology, Ho Chi Minh City, Vietnam
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Kiyon Rhew
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- College of Pharmacy, Dongduk Women’s University, Seoul, South Korea
| | - Patrick J. Antonelli
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
22
|
Wang X, Winterstein AG, Alrwisan A, Antonelli PJ. Risk for Tympanic Membrane Perforation After Quinolone Ear Drops for Acute Otitis Externa. Clin Infect Dis 2019; 70:1103-1109. [DOI: 10.1093/cid/ciz345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/24/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, Gainesville
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, Gainesville
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville
| | | | - Patrick J Antonelli
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville
| |
Collapse
|
23
|
Tympanostomy tube otorrhea in children: prevention and treatment. Curr Opin Otolaryngol Head Neck Surg 2018; 26:437-440. [DOI: 10.1097/moo.0000000000000493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
24
|
Proposal of a Treatment Strategy for Eosinophilic Otitis Media Based on Middle Ear Condition. Otol Neurotol 2018; 39:e671-e678. [DOI: 10.1097/mao.0000000000001912] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Dirain CO, Kosko B, Antonelli PJ. Effects of Common Ear Drops on Tympanic Membrane Healing in Rats. Otolaryngol Head Neck Surg 2018; 158:917-922. [DOI: 10.1177/0194599818757972] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Carolyn O. Dirain
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brendan Kosko
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Antonelli
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
26
|
Redula S, Antonelli PJ, Dirain CO. Cytotoxicity of Ciprofloxacin and Steroids in Mouse Tympanic Membrane Fibroblasts. Otolaryngol Head Neck Surg 2018; 158:547-552. [DOI: 10.1177/0194599817751093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective Ciprofloxacin, commonly given as eardrops, has been shown to adversely affect tympanic membrane fibroblasts. Dexamethasone potentiates this effect. A newly available eardrop contains ciprofloxacin and fluocinolone, a more potent steroid. We evaluated the cytotoxic effects of this preparation on mouse tympanic membrane fibroblasts. Study Design Prospective, in vitro. Setting Academic laboratory. Subjects and Methods In experiment 1, fibroblasts were exposed to 1:10 dilutions of commercially available 0.3% ofloxacin, 0.3% ciprofloxacin, 0.3% ciprofloxacin + 0.1% dexamethasone, 0.3% ciprofloxacin + 0.025% fluocinolone, or dilute hydrochloric acid (control), twice within 24 hours. In experiment 2, cells were also treated with the dilutions of the pure form of dexamethasone 0.1% or fluocinolone 0.025%, alone and in combination with ofloxacin or ciprofloxacin. Cells were exposed to the solutions for 2 hours each time and were placed back in growth media after the treatments. Cells were observed with phase-contrast microscope until the cytotoxicity assay was performed. Results Survival of fibroblasts treated with ofloxacin was not different from the control. Fibroblasts treated with ciprofloxacin, ciprofloxacin + dexamethasone, or ciprofloxacin + fluocinolone had much lower survival (all P < .0001). Cells treated with ciprofloxacin + fluocinolone had lower survival than ciprofloxacin ( P < .0001) and ciprofloxacin + dexamethasone ( P = .0001). Steroids alone also decreased fibroblast survival compared to control ( P < .0001). The combination of dexamethasone or fluocinolone with ciprofloxacin, but not ofloxacin, further decreased fibroblast survival ( P < .0001). Phase-contrast images mirrored the cytotoxicity findings. Conclusion Tympanic membrane fibroblast cytotoxicity of ciprofloxacin is potentiated by corticosteroids. This effect may be deleterious when treating a healing perforation but beneficial when treating granulation tissue on the tympanic membrane.
Collapse
Affiliation(s)
- Sonny Redula
- Department of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Antonelli
- Department of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Carolyn O. Dirain
- Department of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
27
|
Abstract
Objectives To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty. Methods Retrospective review of single surgeon experience. Results During a 3 year period, 30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts. There were 22 boys and 8 girls, ranging in age from 3.5 to 17 years (median 6 years). All tragal cartilage grafts (31/31; 100%) survived. Twenty-seven surgeries (27/31; 82%) resulted in an intact drum (17/31; 55%) or a microperforation (10/31; 32%). In four cases (4/31; 13%) significant perforations formed in previously unaffected portions of the drum. Conclusion Transcanal endoscopic cartilage inlay tympanoplasty offers a practical, minimally invasive approach to tympanoplasty for children of any age. It avoids postauricular or endaural incisions, tympanomeatal flap elevation, and canalplasty. Graft survival is uniform. Microperforation at the graft margins remained in 1/3 of children. Technical modifications may lead to higher rates of tympanic closure.
Collapse
|
28
|
Aminoglycoside or Quinolone Ear Drops in the Postoperative Management of Tympanoplasty: What Choice Do We Have? Otol Neurotol 2017; 38:1548-1549. [PMID: 29065086 DOI: 10.1097/mao.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|