Acute otitis media in children with tympanostomy tubes.

Objective: To review evidence regarding antibiotic treatment of acute otitis media in children with tympanostomy tubes and to discuss antibiotic resistance and ototoxicity.
Quality of Evidence: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for relevant articles. Articles providing level I evidence(randomized controlled trials) for treatment were used. Key words used in the search included otitis media(MeSH), middle ear ventilation (MeSH), tympanostomy tubes, and otorrhea.
Main Message: Tympanostomy tube insertion is a common procedure; acute otitis media is a frequent sequela. Treatment options include systemic or topical antibiotics with or without corticosteroids. The development of bacterial resistance to antibiotics and ototoxicity related to treatment are important considerations. There have been well-conducted randomized controlled trials of topical versus systemic antibiotic agents. Combined with proper ear cleaning and tragal pumping, topical fluoroquinolone agents offer the most effective treatment.
Conclusion: Current evidence suggests that a topical fluoroquinolone, with or without a corticosteroid, is the treatment of choice for acute otitis media with tympanostomy tubes.