Topical treatment for otorrhea: issues and controversies.

Otorrhea is a symptom and not a diagnosis. It can be caused by many disease processes. There are several reasons to consider topical treatment of otorrhea. Two are that greater concentrations can be reached locally of pharmacologically active agents and there is less risk of systemic complications and side effects. One factor that might prevent their efficacy is the formation of biofilms by pathogenic organisms. Topical treatments usually include antimicrobial agents. There is evidence that aminoglycoside-containing drops can cause ototoxicity, particularly insidious vestibular ototoxicity. Nonaminoglycosides are recommended if there is access to the middle ear. There is some evidence that the addition of steroids hastens resolution. There is little evidence on which to estimate the risk reduction of serious complications of otitis media from treatment with topical therapy. In some causes of otorrhea, nonmicrobial treatments might be just as effective. Individualized therapy is recommended.