Introduction.

Otorrhea is a common symptom in both developed and developing countries. In the developed world, otorrhea is frequently associated with the placement of tympanostomy tubes, otitis externa and, less often, chronic suppurative otitis media (CSOM), usually in adults. Among disadvantaged and indigenous communities in developing countries, discharge related to CSOM is frequently found in both children and adults.

Managing otorrhea is the domain of the primary care physician, as well as the ENT surgeon. The elements of management include cleansing the ear to facilitate diagnosis, identifying the infecting organism (by clinical or bacteriologic means), and applying appropriate antimicrobial agents.

Administering the appropriate antimicrobial agent has been historically problematic. Systemic therapy has the advantage of low rates of ototoxicity, but the clear disadvantages of decreased efficacy and often the need for parenteral administration in a hospital setting. Topical administration of medication has the advantage of direct placement of the medication, high concentrations of medication delivered to the site of infection, ease of administration, and a lack of systemic side effects. Unfortunately, the threat of ototoxicity inherent in using topical medications in the setting of an open tympanic cavity has been of both theoretical and practical concern.

The introduction of fluorinated quinolones has revolutionized topical ototherapy. Medications such as ciprofloxacin are specific against the common bacteria that cause otitis externa and against those organisms that are found in CSOM. The efficacy of fluorinated quinolones is equal to or better than that of the traditional topical medications that are known to be ototoxic, and they are superior to systemic medications. The safety of fluorinated quinolones in the open tympanic cavity has been demonstrated in laboratory and clinical trials.

In January 2002, Alcon Laboratories invited 11 clinicians from around the world to participate in a clinical symposium on otorrhea. The topics of discussion included the management of otorrhea following the insertion of tympanostomy tubes, CSOM in indigenous communities and developing countries, CSOM in adulthood, otitis externa, and the management of cerumen. Ototoxicity associated with traditional topical antibiotic therapy and drug resistance was also discussed.

The articles published in this supplement represent the proceedings of that symposium.

Glen R. Croxson, MB, BS, FRACS 

Symposium Chairman