Comparison between vinegar wash and culture based oral antibiotic therapy in active chronic suppurative otitis media
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20170981Keywords:
Otitis media, Acetic acid, PseudomonasAbstract
Background: Chronic otorrhea in chronic suppurative otitis media (CSOM) has become a difficult task to treat for ENT specialists because of emerging resistance to the available antibiotics and patient’s affordability for its cost. Also biofilms have been responsible for the chronicity of disease. Use of vinegar as an antiseptic and altering the pH of middle ear to treat otorrhea in CSOM needs to be studied.
Methods: 120 patients with active CSOM were recruited randomly for either vinegar wash or antibiotic therapy. Vinegar diluted with water in 1:1 ratio at pH 4 was used twice a day for 3weeks to one group. Oral antibiotics based on culture sensitivity report were given to other group for 3weeks. Both groups were followed up for a month and observed for resolution of ear discharge.
Results: Pseudomonas (40%) and Staphylococcus aureus (25%) were the most common organisms detected. 96.2% of Pseudomonas and 50% of Staphylococcus aureus ears became dry with vinegar wash. 81.67% of antibiotic group and 68.33% of vinegar group ears became dry in 3weeks. No statistically significant difference between vinegar wash and culture based oral antibiotic therapy in resolution of ear discharge was seen in active CSOM (p >0.05).
Conclusions: Management of otorrhea is long term in CSOM and vinegar can be used as an alternative to costly oral antibiotics for resolution of ear discharge in active CSOM. Two fold dilution of vinegar prevents chance of ototoxicity.
References
Shrikrishna BH. Ossicular defects in patients with noncholesteatomatous CSOM. OJ Otol HNS 2010;4:14-7.
Roland PS. Chronic suppurative otitis media: a clinical overview. Ear Nose Throat J. 2002;81:8–11.
Kulkarni RD, Dharmadikari CA, Kulkarni VA, Udgaonkar US, Pawar SG. Bacteriological study of chronic otitis media. Indian J Otolaryngol and Head and neck surgery. 1993;2(2):110-2.
Chandrashekhar MR, Krishna BVS, Patil BA. A bacteriological profile of CSOM with pseudomonas aeruginosa as the prime pathogen. Indian J Otol. 2004;10:10-3.
Poorey VK, Iyer A. Study of bacterial flora in CSOM and its clinical significance. Indian J Otolaryngol and Head and Neck Surg. 2002;54(2):91-5.
Malkappa SK, Kondapaneni S, Surpam RJ, Chakraverti TK. Study of aerobic bacterial isolates and their antibiotic susceptibility pattern in chronic suppurative otitis media. Indian J Otol. 2012;18(3):136-9.
Vishwanath S, Mukhopadhyay C, Prakash R. Chronic Suppurative Otitis Media: Optimizing Initial Antibiotic Therapy in a Tertiary Care Setup. Indian J Otolaryngol Head Neck Surg. 2012;64(3):285–9.
Maji PK, Chatterjee TK, Chatterjee S. The investigation of bacteriology of chronic suppurative otitis media in patients attending a tertiary care hospital with special emphasis on seasonal variation. Indian J Otolaryngol Head Neck Surg. 2007;59:128-31.
Deb T, Ray D. A Study of the Bacteriological Profile of Chronic Suppurative Otitis Media in Agartala. Indian J Otolaryngol Head Neck Surg. 2012;64(4):326–9.
Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. Med Gen Med. 2006;8(2):61.
Jones EH, McLain PG. Does acid pH inhibit bacterial growth in the external ear canal. The Laryngoscope. 1961;71:928-36.
Mittal A, Sunil Kumar. Role of pH of External Auditory Canal in Acute Otitis Externa. Indian J Otolaryngol Head Neck Surg. 2014;66(1):86–91.
Somayaji KSG, Rajeshwari A. Vinegar in ear diseases. Indian J Otol. 2006;12:14-7.
Gupta C, Agrawal A, Gargav ND. Role of Acetic Acid Irrigation in Medical Management of Chronic Suppurative Otitis Media: A Comparative Study. Indian J Otolaryngol Head Neck Surg. 2015;67(3):314-8.
Choi HG, Park HK, Park SN, Jun BC, Lee DH, Yeo SW. The appropriate medical management of methicillin-resistant Staphylococcus aureus in chronic suppurative otitis media. Acta Oto-Laryngologica 2010;130:42-6.
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.
Aminifarshidmehr N. The management of Chronic Suppurative Otitis Media with acid media solution. The Am J Otol. 1996;17(1):24-5.
Sugamura M, Yamano T, Higuchi H, Takase H, Yoshimura H, Nakagawa T, et al. Ototoxicity of Burrow solution on the guinea pig cochlea. American J Otolaryngol. 2012;33:595-9.
Yamano, Higuchi H, Nakagawa T, Morizono T. Ototoxicity of acetic acid on the guinea pig cochlea. J Otolaryngol Head and Neck Surg. 2015;44:54.
