Boric acid treatment equals best practice for otitis media

By Ingrid Grasmo, MedWire Reporter

Study findings show that a single application of boric acid powder followed by external auditory canal irrigation is as effective as topical ciprofloxacin eardrops for treating active chronic otitis media (COM).

Ciprofloxacin is currently the gold standard for treating COM, but it is expensive, requires patient compliance in administration, and can potentially result in resistance.

"Various non-antibiotic antiseptic agents have been studied, but none proved to be significantly effective. Boric acid powder is a viable, less costly alternative to topical antibiotic/steroid ear drops in the developing world for chronic otitis media," say J Loock (University of Stellenbosch, Cape Town, South Africa) and colleagues.

In total, 159 patients older than 6 years of age with active chronic mucosal otitis media were randomly assigned to receive a one-off treatment with boric acid powder, courses of 1% acetic acid, or ciprofloxacin ear drops. Topical betamethasone cream was applied as a second-line treatment in patients showing resistance to first-line therapy.

All ears underwent irrigation until the perforation was visible and the treatment of choice was flushed through the middle ear and Eustachian tube using a "tragal pump" technique.

Follow-up 4 weeks after the initial treatment revealed that ciprofloxacin drops and boric acid were both superior to 1% acetic acid in rendering COM inactive, at rates of 73% and 65% versus 25%, respectively.

Furthermore, 92% and 79% of patients judged their ears to be "completely dry" following treatment with ciprofloxacin drops and boric acid, respectively, compared with just 33% of those receiving 1% acetic acid.

Of the 76 patients with dry ears at follow-up, 59% attended for a second follow-up 4 weeks later and the dry status was maintained in 92%. Further analysis revealed that, at this time, the best outcomes for dry status were achieved with boric acid powder (100% of ears remained dry), followed by ciprofloxacin (88%), and 1% acetic acid (78%).

Among patients who presented with "moist" ears (n=19) at the second visit, 53% were dry at the next visit. Again, boric acid powder provided the best results, with 100% of ears going from moist to dry, compared with 75% with ciprofloxacin drops, and 40% with 1% acetic acid.

Betamethasone cream was effective in 85% of patients failing first-line therapy. No significant complications were observed with any of the treatments and no hearing loss was detectable following audiometric testing.

"In keeping with previous studies… topical quinolone eardrops [are] successful in the management of active COM. Boric acid powder has the further advantages of being extremely inexpensive, requiring minimal patient compliance, and not inducing bacterial resistance," write the researchers in the journal Clinical Otolaryngology.

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