A child with tympanostomy tubes develops drainage for two weeks. What is the recommended management?

• A. Refer to ENT for tubes.
• B. Topical ofloxacin ear drops for 5 days.
• C. Systemic antibiotics.
• D. Watchful waiting.

Answer: (B)

Post-tympanostomy tube otorrhea is best treated with topical antibiotic drops because the tube provides direct access to the middle ear, allowing high concentrations of the antibiotic at the site of infection while minimizing systemic exposure. In a child with persistent drainage for two weeks, a topical broad-spectrum agent such as an fluoroquinolone ear drop (for example, ofloxacin) for about five days effectively covers common pathogens like Staph aureus and Pseudomonas. This approach avoids unnecessary systemic antibiotics and their side effects, which aren’t typically needed for localized tube-related otorrhea. Watchful waiting isn’t appropriate here due to the prolonged drainage, and referral to ENT isn’t needed unless there are complications or tube-related issues.