MRSA drainage from the Ears–We Can Handle It

MRSA Drainage From the Ears Is Not A Scary Problem

A new study recently published in one of the more prominent ENT medical journals discusses how MRSA (methicillin-resistant staphylococcus aureus) drainage following the placement of tubes does not lead to more serious complications or surgery compared to kids who have non-MRSA drainage.

Let me first try to clarify a couple of things so that we all have a few basic principles down. Drainage from the ears is called otorrhea. When this drainage occurs after the placement of tubes in the ears, it is then called post-tympanostomy otorrhea (PTO). Tympanostomy means making a hole in the ear drum, usually where the tube is placed.

otorrhea when draining from the ear
original photo from hawkelibrary.com

This study provides comfort for both ENT’s and the parents of children with tubes because MRSA is by definition a resistant bacteria and can cause in some circumstances a significant health risk. However, it is clear from this study that it is not as threatening when it is the cause of otorrhea. Most ENT’s have recognized an increase in this type of bacterial drainage and even though it is tougher to stop that many other causes of otorrhea, it has appeared in our experience to not cause an increase risk of serious problems.

what a PE tube looks like in the ear drum
PTO comes through the hole to drain out the ear like above
One problem that I see with many patients after tubes go in is that if there is drainage, parents are told that it is normal and means the tubes are working. While this is technically correct, I wouldn’t call it normal. Common is a better term. In terms of percentages, 50% of kids will have 1 episode of drainage with tubes in place, 35% of kids will have no drainage ever, but only 15% have multiple episodes of drainage. If you see the kind of drainage shown in the picture above, it indicates that there is an infection.
The second problem I see with PTO is that often kids are given oral antibiotics as a first line treatment. Unless there are some significant contraindications, first line treatment for tubes is drops. Ciprodex (ciprofloxacin/dexamethoasone) and Floxin (oflaxacin) while both quite expensive are currently the only drops that are FDA approved for PTO. Your ENT may occasionally suggest other drops for specific reasons.
Take home message is this:
1 – Otorrhea = an infection
2 – Treatment = drops

 

Posted in: Ear

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