Antibiotic prophylaxis in clean and clean-contaminated ear surgery

Background

Ear surgery may be performed in the treatment of chronic otitis media, ossicular chain disorders, tympanic membrane perforations and otitis media with effusion. Postoperative infection in ear surgery may result in:

• Wound infections;
• Infection of the middle ear or mastoid resulting in discharge from the ear canal;
• Failure of the tympanic membrane to close; or
• Labyrinthitis due to infection in, or adjacent to, the inner ear.

These complications may be associated with discomfort and inconvenience for the patient, an increase in morbidity and an increase in the costs of medical care.

Objectives

The objective of this review was to assess the effects of local and/or systemic antibiotics for preventing complications such as postoperative discharge, graft failure and labyrinthitis in patients undergoing clean or clean-contaminated ear surgery.

Search strategy

This review was updated in 2007. Our search included MEDLINE (January 1966 to June 2007), EMBASE (January 1974 to June 2007), the Science Citation Index, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2 2007), the Cochrane Acute Respiratory Infections Group and Cochrane Ear, Nose and Throat Group Trials Registers and proceedings of scientific meetings. The date of the last search was June 2007. We also contacted investigators in the field (Govaerts, Antwerp). Bibliographies of identified articles were screened for further relevant trials. No language restriction was applied.

Selection criteria

Randomised or quasi-randomised trials involving:

• Participants: patients undergoing clean or clean-contaminated types of ear surgery. Skull base surgery was excluded.
• Intervention: any regimen of local and/or systemic antibiotic prophylaxis administered at or around the time of surgery compared to placebo, no antibiotic, or an alternative intervention group.
• Outcome measures: infection, discharge, graft failure, labyrinthitis, adverse effects of prophylaxis.

Data collection and analysis

When possible, investigators were contacted for additional information on data and methodological issues. At least two authors independently extracted data and assessed trial quality.

Main results

Eleven studies were included in the review. The methodological quality of the trials was fair to good. However, most studies presented insufficient detail on methodological data. Although definitions of outcome measures were heterogeneous, pooling of results was possible. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of postoperative infections, graft failures, draining outer ear canals and adverse drug effects.

Authors' conclusions

There is no strong evidence that the large scale use of prophylactic of antibiotics in clean and clean-contaminated ear surgery is helpful in reducing postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis and graft failure.