1
|
Bhutta MF, Leach AJ, Brennan-Jones CG. Chronic suppurative otitis media. Lancet 2024; 403:2339-2348. [PMID: 38621397 DOI: 10.1016/s0140-6736(24)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation.
Collapse
Affiliation(s)
- Mahmood F Bhutta
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK; Department of ENT, Royal Sussex County Hospital, Brighton, UK.
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Darwin, NT, Australia
| | - Christopher G Brennan-Jones
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Ear Health Group, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
2
|
Waldman EH, Ingram A, Vidrine DM, Gould AR, Zeiders JW, Ow RA, Thompson CR, Moss JR, Mehta R, McClay JE, Brenski A, Gavin J, Ansley J, Yen DM, Chadha NK, Murray MT, Kozak FK, York C, Brown DM, Grunstein E, Sprecher RC, Sherman DA, Schoem SR, Puchalski R, Hills S, Harfe D, England LJ, Syms CA, Lustig LR. Two-Year Outcomes After Pediatric In-Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System. Otolaryngol Head Neck Surg 2023; 169:701-709. [PMID: 37003297 DOI: 10.1002/ohn.336] [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: 11/11/2022] [Revised: 02/02/2023] [Accepted: 02/25/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Evaluate 2-year outcomes after lidocaine/epinephrine iontophoresis and tympanostomy using an automated tube delivery system for pediatric tube placement in-office. STUDY DESIGN Prospective, single-arm. SETTING Eighteen otolaryngology practices. METHODS Children age 6 months to 12 years indicated for tympanostomy were enrolled between October 2017 and February 2019. Local anesthesia of the tympanic membrane was achieved via lidocaine/epinephrine iontophoresis and tympanostomy was completed using an automated tube delivery system (the Tula® System). An additional Lead-In cohort of patients underwent tube placement in the operating room (OR) under general anesthesia using only the tube delivery system. Patients were followed for 2 years or until tube extrusion, whichever occurred first. Otoscopy and tympanometry were performed at 3 weeks, and 6, 12, 18, and 24 months. Tube retention, patency, and safety were evaluated. RESULTS Tubes were placed in-office for 269 patients (449 ears) and in the OR for 68 patients (131 ears) (mean age, 4.5 years). The median and mean times to tube extrusion for the combined OR and In-Office cohorts were 15.82 (95% confidence interval [CI]: 15.41-19.05) and 16.79 (95% CI: 16.16-17.42) months, respectively. Sequelae included ongoing perforation for 1.9% of ears (11/580) and medial tube displacement for 0.2% (1/580) observed at 18 months. Over a mean follow-up of 14.3 months, 30.3% (176/580) of ears had otorrhea and 14.3% (83/580) had occluded tubes. CONCLUSION In-office pediatric tympanostomy using lidocaine/epinephrine iontophoresis and automated tube delivery results in tube retention within the ranges described for similar grommet-type tubes and complication rates consistent with traditional tube placement in the OR.
Collapse
Affiliation(s)
- Erik H Waldman
- Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | - Amy Ingram
- Advanced ENT & Allergy, Louisville, Kentucky, USA
| | - D Macy Vidrine
- South Carolina ENT Allergy & Sleep Medicine (SCENT), Columbia, South Carolina, USA
| | | | - Jacob W Zeiders
- South Florida Pediatric Otolaryngology, Fort Lauderdale, Florida, USA
| | - Randall A Ow
- Sacramento Ear, Nose and Throat, Roseville, California, USA
| | | | - Jonathan R Moss
- Charlotte Eye Ear Nose & Throat Associates (CEENTA), Matthews, North Carolina, USA
| | - Ritvik Mehta
- California Head and Neck Specialists, Carlsbad, California, USA
| | - John E McClay
- Cook Children's Physician Network, Frisco, Texas, USA
| | - Amy Brenski
- Cook Children's Physician Network, Frisco, Texas, USA
| | - John Gavin
- Albany ENT and Allergy, Albany, New York, USA
| | - John Ansley
- Carolina Ear Nose & Throat Clinic, Orangeburg, South Carolina, USA
| | - David M Yen
- Specialty Physician Associates, Bethlehem, Pennsylvania, USA
| | - Neil K Chadha
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Frederick K Kozak
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - David M Brown
- Specialty Physician Associates, Bethlehem, Pennsylvania, USA
| | - Eli Grunstein
- Columbia University Irving Medical Center, New York City, New York, USA
| | | | - Denise A Sherman
- Nemours Children's Health, Jacksonville, Jacksonville, Florida, USA
| | - Scott R Schoem
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Robert Puchalski
- South Carolina ENT Allergy & Sleep Medicine (SCENT), Columbia, South Carolina, USA
| | - Susannah Hills
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Dan Harfe
- Smith+Nephew Inc., Menlo Park, California, USA
| | | | | | - Lawrence R Lustig
- Columbia University Irving Medical Center, New York City, New York, USA
| |
Collapse
|
3
|
Bruno C, Guidi M, Locatello LG, Gallo O, Trabalzini F. Current outcomes of myringoplasty in a European referral children's hospital. Int J Pediatr Otorhinolaryngol 2022; 160:111246. [PMID: 35863147 DOI: 10.1016/j.ijporl.2022.111246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Myringoplasty is a frequently performed procedure in children, with a heterogeneous failure rate. Our study aimed to evaluate the outcome of myringoplasty in a pediatric hospital and to identify which are risk factors for reperforation or poor hearing improvement after surgery. METHODS Preoperative and intraoperative variables between pediatric patients who had undergone myringoplasty with an intact tympanic membrane at follow-up and the cases with reperforation were compared. The same factors were investigated as potential predictors of audiological success. Pre and postoperative PTA and ABG were compared in the whole population, in structural success and failure groups and closure of ABG was calculated and used to compare the audiological outcomes between the two groups. RESULTS Parameters that affected the postoperative integrity of TM were age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure. Early perforations occurred mostly after surgeries performed by trainees, while late perforations were more frequently in autumn. Myringoplasty, regardless of the structural outcome, can improve the ABG and PTA. No preoperative and intraoperative parameters affected the audiological outcome. CONCLUSION Pediatric myringoplasty is a safe and successful procedure that can improve hearing, regardless of the structural outcome. In light of our results, parameters to consider before surgery are age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure.
Collapse
Affiliation(s)
- Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy.
| | - Mariapaola Guidi
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
| |
Collapse
|
4
|
Gonçalves AI, Rato C, Duarte D, de Vilhena D. Type I tympanoplasty in pediatric age - The results of a tertiary hospital. Int J Pediatr Otorhinolaryngol 2021; 150:110899. [PMID: 34450544 DOI: 10.1016/j.ijporl.2021.110899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/28/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The performance of pediatric tympanoplasty is a matter of controversy in the literature, varying from 35 to 94%. Several authors argue that the performance of tympanoplasty should be delayed until 6-8 years old or even after 10 years old. OBJECTIVES To analyze the results of type I tympanoplasty in pediatric age and to identify possible prognostic factors. MATERIAL AND METHODS Retrospective study of children undergoing type I tympanoplasty (Portmann's classification) between January 2012 and December 2018 in our hospital. The following variables were analyzed: age, gender, etiology, size and location of the perforation, operated ear, season of the surgery, experience of the surgeon, condition of the contralateral ear, previous otologic surgery, previous adenoidectomy, presence of tympanosclerosis, surgical approach, type of graft, tympanoplasty technique, pre and postoperative audiometric results and follow-up time. The integrity of tympanic membrane (TM) was defined as anatomical success at 6 months postoperatively and as functional success we defined a pure tone average < 20 dB (mean of 0.5-4 KHz) in postoperative tonal audiometry, performed between 3 and 6 months after surgery. RESULTS A total of 48 ears operated on 38 patients, aged between 8 and 17 years. Anatomical and functional success rates of 81.3% and 87.5%, respectively, were obtained. The only statistically significant poor prognostic factor was the presence of tympanosclerosis plaques in the middle ear, negatively affecting anatomical success (p = 0.007) and functional success (p = 0.008). There was an anatomical failure rate of 25% in the anterior and lower TM perforations, 14.3% in central and 7.7% in posterior perforations (p = 0.603). Perforations >50% of the TM surface showed a functional failure rate of 25% vs. 10% in perforations <50% of the TM (p = 0.242) and anatomical failure rates of 12.5% vs. 20%, respectively (p = 0.620). Regarding age, the group <12 years had an anatomical success rate of 85.7%, while the group ≥12 years had a rate of 79.4% (p = 0.611). As for the functional success rates, this was 92.9% and 85.3%, respectively (p = 0.471). Apart from the presence of tympanosclerosis, no other variable was statistically significantly associated with surgical success. CONCLUSIONS Our study shows that type I tympanoplasty in pediatric age is a procedure with a high rate of anatomical and functional success. The presence of tympanosclerosis plaques in the middle ear was the only factor associated with poor anatomical and functional prognosis. Contrary to what has been described in some articles in the literature, in this study, the functional and anatomical success rates did not vary according to the age group.
Collapse
Affiliation(s)
| | - Catarina Rato
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Delfim Duarte
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Ditza de Vilhena
- Otolaryngology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| |
Collapse
|
5
|
Mantsopoulos K, Thimsen V, Richter D, Müller SK, Sievert M, Iro H, Hornung J. Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage? Am J Otolaryngol 2021; 42:103122. [PMID: 34166961 DOI: 10.1016/j.amjoto.2021.103122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Performing tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults. OBJECTIVES The aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate. MATERIALS UND METHODS The present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy). RESULTS 83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6-182 months). The anatomical closure rate was 88.0%. Children with "dry" tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB. CONCLUSION Detailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.
Collapse
Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
| | - Vivian Thimsen
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Daniel Richter
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Joachim Hornung
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| |
Collapse
|
6
|
A Hierarchy of Proliferative and Migratory Keratinocytes Maintains the Tympanic Membrane. Cell Stem Cell 2020; 28:315-330.e5. [PMID: 33181078 DOI: 10.1016/j.stem.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/30/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022]
Abstract
The tympanic membrane (TM) is critical for hearing and requires continuous clearing of cellular debris, but little is known about homeostatic mechanisms in the TM epidermis. Using single-cell RNA sequencing, lineage tracing, whole-organ explant, and live-cell imaging, we show that homeostatic TM epidermis is distinct from other epidermal sites and has discrete proliferative zones with a three-dimensional hierarchy of multiple keratinocyte populations. TM stem cells reside in a discrete location of the superior TM and generate long-lived clones and committed progenitors (CPs). CP clones exhibit lateral migration, and their proliferative capacity is supported by Pdgfra+ fibroblasts, generating migratory but non-proliferative progeny. Single-cell sequencing of the human TM revealed similar cell types and transcriptional programming. Thus, during homeostasis, TM keratinocytes transit through a proliferative CP state and exhibit directional lateral migration. This work forms a foundation for understanding TM disorders and modeling keratinocyte biology.
Collapse
|
7
|
Wang MC, Chu CH, Wang YP. Epidemiology of common otologic surgical procedures in pediatric patients: A population-based birth cohort study. Int J Pediatr Otorhinolaryngol 2019; 127:109644. [PMID: 31442732 DOI: 10.1016/j.ijporl.2019.109644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It is generally recognized the most common pediatric otologic surgical procedure is ventilation tube insertion (VTI). Tympanoplasty and mastoidectomy are more frequently performed on adults. In this study we examined the incidence and age distribution of these procedures by use of a population-based birth cohort design, in order to provide an overall view of the role of these procedures in the pediatric population. MATERIALS AND METHODS We used the national health insurance research database in Taiwan. We retrieved data on all patients born in the years 2000 and 2001, subsequently underwent VTI, tympanoplasty or mastoidectomy from 2000 to 2013. The incidence and age distribution of these procedures were analyzed. RESULTS The cumulative incidence of VTI, tympanoplasty, and mastoidectomy was 0.41%, 0.02% and 0.025%, respectively. VTI were more often performed on children 4 or 5 years of age. Tympanoplasties are frequently done on children older than 5, and 30.7% of them had earlier VTI. The time interval from VTI to tympanoplasty was 5.18 ± 2.27 years (mean ± SD). Mastoidectomies are more often performed on children from 2 to 9 years of age. CONCLUSIONS VTI was the most frequent otologic surgery for the pediatric population, and was more often performed on children 4-5 years old. Also, tympanoplasty is more frequently performed on children older than 5, and a third of them had prior VTI. Overall, the time interval from VTI to tympanoplasty was 5.18 years. Furthermore, children with cleft palate and congenital metabolic disorder were more prone to otologic surgical procedures.
Collapse
Affiliation(s)
- Mao-Che Wang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Huei Chu
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taiwan and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Piao Wang
- Department of Otolaryngology Head Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan.
| |
Collapse
|
8
|
Pediatric partial gelfoam myringoplasty with ventilation tube placement. Int J Pediatr Otorhinolaryngol 2019; 126:109632. [PMID: 31419743 DOI: 10.1016/j.ijporl.2019.109632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE For children with a history of persistent Eustachian tube dysfunction (ETD) or otitis media with effusion presenting with recurring tympanic membrane (TM) perforation, surgeons must often balance the treatment goals of correcting the perforation and maintaining ventilation to the middle ear to prevent future perforation formation. A partial gelfoam myringoplasty with ventilation tube placement is a previously unreported procedural option for addressing these goals. The objective of this study is to describe the partial myringoplasty technique and report preliminary outcome data for the procedure. METHODS Retrospective cohort study of 29 children <18 years old undergoing partial myringoplasty at a tertiary care children's hospital or satellite location. Size and course of initial perforation, time to tube extrusion, audiogram findings, and need for future otological procedures were studied. RESULTS During a partial myringoplasty, a tympanostomy tube is placed in a TM perforation larger than the tube itself. The edges of the perforation are freshened, a tube is placed, and a piece of gelfoam is inserted to support the tube and to cover any remaining perforation. Out of 32 ears in 29 patients, 23 procedures were completed to correct existing perforations. The remainder were indicated in placement (n = 7) or replacement (n = 2) where the myringotomy or existing perforation was deemed too large to retain the tympanostomy tube without further support due to atelectatic or monomeric tympanic membranes. Thirteen tubes extruded within 1 year, of which 12 were Armstrong tubes and 1 was a T-tube. Out of 25 TM perforations corrected, 4 shrank in size and 2 did not close. For patients who underwent pre-surgical audiograms with findings indicating conductive hearing loss and had post-operative audiograms at follow-up, 8/10 showed improvement and 2/10 showed no change in hearing. CONCLUSION A partial myringoplasty is a simple procedure to close existing TM perforations while maintaining ventilation to the middle ear that can potentially improve hearing, provide ongoing ventilation, and eventually result in TM closure without the need for more complex repair. It may serve as a reasonable first line treatment for repair of perforations, reserving tympanoplasty for patients who fail this procedure.
Collapse
|
9
|
Winterstein AG, Liu W, Xu D, Antonelli PJ. Sensorineural Hearing Loss Associated with Neomycin Eardrops and Nonintact Tympanic Membranes. Otolaryngol Head Neck Surg 2012; 148:277-83. [DOI: 10.1177/0194599812471499] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Use of neomycin eardrops in nonintact tympanic membranes (NITMs) due to tympanic membrane (TM) perforation or tympanostomy tubes (TTs) is controversial because of the potential for ototoxicity. We sought to compare the risk of sensorineural hearing loss (SNHL) in patients with NITMs who received neomycin with those who received fluoroquinolone eardrops. Study Design Retrospective cohort study. Setting Administrative claims data analysis, including diagnoses and procedure detail for physician office and hospital visits and pharmacy dispensing events in children eligible for Medicaid fee-for-service benefits in 29 states between 1999 and 2006. Subjects and Methods Eligible patients (age <18 years) had to have received a study eardrop within 12 months after first diagnosis of NITM. The follow-up period started from the first eardrop dispensing. Main Outcome Measures We compared the 12-month risk of SNHL using Cox proportional hazards regression models adjusted for SNHL risk factors. Results We found 982 SNHL cases in 134,598 children treated with neomycin or fluoroquinolone eardrops. The adjusted hazard ratio (HR) for 1, 2, and 3 or more prescriptions of neomycin was 0.90 (95% confidence interval [CI], 0.76-1.07), 1.45 (1.05-2.01), and 1.30 (0.71-2.36), respectively, when adjusted for SNHL risk factors, the interval between initial diagnosis of NITM and eardrop initiation, and total number of eardrop prescriptions. The results remained unchanged for several sensitivity analyses. Conclusion Short-term use of neomycin eardrops in patients with NITMs is not associated with an increased risk of SNHL; however, repeated doses (ie, ≥2 prescriptions) showed a significant association with an increased risk of SNHL.
Collapse
Affiliation(s)
- Almut G. Winterstein
- Department of Pharmaceutical Outcome and Policy, College of Pharmacy, 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
| | - Wei Liu
- Department of Pharmaceutical Outcome and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Dandan Xu
- Department of Pharmaceutical Outcome and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Antonelli
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|