Role of 1.5% acetic acid irrigation and medical management in chronic persistent suppurative otitis media


  • Bhavya Kanakarajulu Department of otorhinolaryngology, Santhiram Medical College and General Hospital, Nandyal, Andhra Pradesh, India
  • Lanke Sowmya Department of otorhinolaryngology, Santhiram Medical College and General Hospital, Nandyal, Andhra Pradesh, India
  • Teja . Department of otorhinolaryngology, Santhiram Medical College and General Hospital, Nandyal, Andhra Pradesh, India





Background: Chronic ear discharge in chronic suppurative otitis media (CSOM) persisting for more than two weeks has become difficult to treat for ENT specialists due to resistance to the available antibiotics and patient's affordability for its cost. Also, biofilms have been responsible for the disease and cause tympanic membrane perforation and deafness. The use of 1.5% acetic acid irrigation acts as an antiseptic, and altering the middle ear's pH to treat otorrhea in CSOM needs to be studied. Aim of the study to assess results of 1.5% acetic acid irrigation and topical and systemic antibiotic in CSOM and to consider the most appropriate medical management

Methods: A total of 100 patients of CSOM was divided equally into two groups. Group 1 patients were treated with 1.5% acetic acid irrigation every other day, and group 2 was treated with topical and systemic antibiotics three drops’ times daily. Follow up of both groups every week up to symptomatic relief.

Results: Otorrhoea resolution in the group treated with acetic acid was 88%, and healing of perforation was noted in 28 %, while the failure rate of 12%.

Conclusions: Medical management of persistent CSOM with tubotympanic type by frequent aural cleaning, 1.5% acetic acid irrigation can be the more desirable choice than the topical and oral antibiotics. It is safe without any side effects and economical. Alteration of ear canal PH is one of the main factors for healing, in addition to mechanical disruption of biofilm and removal of deep-seated debris.



Choi HG, Park KH, Park SN, Jun BC, Lee DH, Yeo SW. The appropriate medical management of methicillin-resistant Staphylococcus aureus in chronic suppurative otitis media. Acta Otolaryngol. 2010;130(1):42-6

Post JC, Hiller NL, Nistico L, Stoodley P, Ehrlich GD. The role of biofilms in otolaryngologic infections (Update 2007). Curr Opin Otolaryngol Head Neck Surg. 2007;15(5):347-51.

Jones CE, Kennedy JP. Treatment options to manage wound biofilm. Adv Wound Care (New Rochelle). 2012;1(3):120-6.

Macassey E, Dawes P.Biofilms and their role in otorhinolaryngological disease. J Laryngol Otol. 2008;122:1273-8.

Chronic Suppurative Otitis media: burden of illness and management options. Child and Adolescent Health and Development, Prevention of Blindness and Deafness. World Health Organization. Geneva, Switzerland. 2004;14-9.

WHO/PDH Prevention of hearing impairment from chronic Otitis media. Report of WHO/CIBA Foundation workshop, Geneva. 1996;19-21.

Vishwakarma K, Khan FA, Nizamuddin S, Yadav L. Role of Topical Acetic Acid in Comparison to Gentamicin for the Management of Chronic Suppurative Otitis Media. Int Arch BioMed Clin Res. 2015;1(1):13-6.

Roland PS. Chronic suppurative otitis media: a clinical overview. Ear Nose Throat. 2002;81:8-11.

Malik MK, Dayal D, Khan AM. In vitro and in vivo evaluation of change of local pH on bacteria in chronic suppurative otitis media. J Laryngol Otol. 1975;89:837-43.

Chhangani DL, Goyal OP. Bacteriological study in chronic suppurative otitis media. Indian J Otol. 1976;28:41-5.

Fradis M, Brodsky A, Ben-David J, Srugo I, Larboni J, Podoshin L. Chronic otitis media treated topically with ciprofloxacin and tobramycin. Arch Otolaryngol Head Neck Surg. 1997;123:1057-60.

Supiyaphun P, Kerekhanjanarong V, Koranasophonepun J, Sastarasadhit V. Comparison of ofloxacin otic solution with oral amoxicillin plus chloramphenicol ear drop in the treatment of chronic suppurative otitis media with acute exacerbation. J Med Assoc Thail. 200;83(1):61-8.

Fabricant ND, Perlstein MA. pH of the cutaneous surface of the external auditory canal. Arch Otolaryngol. 1949;49:201-9.

Ludman H. Discharge from the ear: otitis externa and acute otitis media. BMJ. 1980;281:1616-7.

Nelson SM, Berry RI. Ear disease and hearing loss among Navajo children: a mass survey. Laryngoscope. 1984;94:316-23.

Dellamonica P, Choutet P, Lejeune JM, Lucht F, Morgon A, Pessey JJ et al. Efficacy and safety of cefotiam hexetil in the treatment of chronic otitis media. A comparative double-blind randomized study versus cefuroxime axetil. Med Mal Infect. 1995;25(5):733-9.






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