Masters Degrees (Otorhinolaryngology)

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    Evaluation of topical 5% povidone iodine solution in chronic suppurative otitis media: a case series
    (Stellenbosch : Stellenbosch University, 2023-03) Boggenpoel, Ashton; Adam, Shaun; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Otorhinolaryngology.
    ENGLISH ABSTRACT: Introduction: Chronic otitis media (COM) is a major public health concern in developing and developed countries. Early detection and appropriate management of these cases are critical for minimising the complications associated with this disease. The gold standard treatment is quinolone eardrops with or without steroids. However, quinolone ear drops are expensive, not readily available in developing countries. Antiseptics provide broad-spectrum antibacterial and antifungal effects, are cost-effective, and reduce the likelihood of organisms developing resistance. Povidone (polyvinyl pyrrolidone)-iodine (PVP-I) has been widely utilised for numerous clinical applications on skin and mucosa for the past 30 years with no significant local or systemic side effects and is cost-effective. 5 Gram-positive and gram-negative bacteria, anaerobes, spores, mycobacteria, fungi, viruses, and protozoans are all susceptible to its broad antibacterial range.6 Aim: This case series aims to assess the efficacy of topically applied 5% povidone-iodine (PVP-I) in the treatment of active COM. This was measured as the resolution of active COM ears. Methods: The study design is a prospective case-controlled series. All subjects presenting to the otorhinolaryngology department with discharging ears and who met the inclusion criteria, were entered into the study. A total of 51 (39 subjects) ears were allocated to receive 5% PVPI. Six drops were administered twice daily to the affected ears. Subjects were followed up at four weeks after the initial consultation. During their review visit, an evaluation by microscopic examination was performed. Ears were graded as actively discharging (wet) deemed as failure or inactive (dry) deemed successful. This formed the main outcome measure. Outcomes: In this case series bidaily administration of 5% PVP-I solution led to a clinical improvement in 89.47% of ears, whereas 10.53 % of ears had treatment failure. This outcome was comparable to other studies using 5% PVP-I. Previous studies had more frequent consultations and aural toilets, while participants in this case only had two consultations and two aural toilets, yielding the same outcome. Conclusion: This study demonstrates that 5% PVP-I solution is an inexpensive and effective treatment for active COM. 5%PVI-I solution serves as an excellent alternative in resource limited settings where quinolone ear drops are not widely available. In the South African context, in particular the public health care system, this may translate to reduced healthcare costs and an equally effective treatment option when quinolone eardrops are not readily available.