Comparison between vinegar wash and culture based oral antibiotic therapy in active chronic suppurative otitis media

Supreetha B. Shenoy, Raveendra P. Gadag, Somanath B. Megalamani, Annapurna S. Mushannavar


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.


Otitis media, Acetic acid, Pseudomonas

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