Treatment of Ear Tubes and Discharge in Adults

First-Line Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) as the first-line treatment for adults with ear tubes and discharge, administered twice daily for up to 10 days 1, 2
Clinical cure rates with topical therapy range from 77% to 96%, significantly higher than systemic antibiotics (30% to 67%) 1, 2
Topical therapy provides higher drug concentration at the infection site and better coverage of likely pathogens, especially Pseudomonas aeruginosa 1, 3

Clean the ear canal of debris or discharge before administering drops, using a cotton-tipped swab with hydrogen peroxide or warm water, or gentle suction with an infant nasal aspirator 1, 3, 4, 5
After instilling drops, "pump" the tragus (flap of skin in front of ear canal) several times to help the drops enter the ear tube 3, 5

Prevent water entry into the ear canal during treatment by using cotton saturated with Vaseline to cover the opening during bathing or hair washing, and avoid swimming until the drainage stops 5
Limit topical therapy to a single course of no more than 10 days to avoid fungal (yeast) infections of the ear canal 1, 5

Systemic antibiotics may be appropriate in specific situations, such as cellulitis of the pinna or adjacent skin, concurrent bacterial infection elsewhere, signs of severe infection, or persistent or worsening discharge despite topical antibiotic therapy 3

Common pathogens in ear tube discharge include Pseudomonas aeruginosa, Staphylococcus aureus, and typical respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) 1
MRSA should be suspected in recurrent or recalcitrant cases 1

Topical therapy avoids adverse events associated with systemic antibiotics (dermatitis, allergic reactions, GI upset, oral thrush) and reduces potential for increased antibiotic resistance 1, 2
Only topical drops approved for use with tympanostomy tubes should be prescribed (quinolone drops with or without steroid), and aminoglycoside-containing eardrops should be avoided due to potential ototoxicity 1

If discharge continues for more than 7 days despite treatment, follow-up with an otolaryngologist is recommended 5
Routine follow-up every 4-6 months is important to ensure tubes are functioning properly 6