Does Topical Steroid Use Increase the Risk for Subsequent Tympanoplasty?

Objectives: Although the current data support the notion that combination therapy of topical steroids with antibiotics is a safe, and often superior, option for suppurative otitis media when compared to topical antibiotics alone, little is known about the impact of topical steroids on tympanic membrane (TM) healing and risk of residual perforation. This study aims to describe the long-term impact the addition of topical steroids to antibiotics has on TM healing, as measured by rates of subsequent tympanoplasty.

Methods: Electronic health records were queried using TriNetX Research Network to construct cohorts of adult patients with "infected" TM perforation (ICD-10 code H66) and "noninfected" TM perforation (ICD-10 code H72). Both groups were further divided based on treatment with ofloxacin or ciprofloxacin/dexamethasone (RxNorm codes). The measured outcome was whether or not the patient underwent tympanoplasty without mastoidectomy or ossicular reconstruction within 2 years following diagnosis and treatment.

Results: In "infected" patients, the ciprofloxacin/dexamethasone cohort demonstrated a small but significantly increased risk of undergoing tympanoplasty (1.12%) compared to the ofloxacin cohort (0.76%, p < 0.05). In "noninfected" patients, the ciprofloxacin/dexamethasone cohort demonstrated a significantly increased risk of undergoing tympanoplasty (6.87%) compared to the ofloxacin cohort (5.67%, p < 0.05).

Conclusion: In the setting of acute suppurative otitis media, there is a small but statistically significant increased risk of residual TM perforation when patients receive ciprofloxacin/dexamethasone compared to ofloxacin. However, the clinical significance of this risk must be weighed against the curative and symptomatic benefits of ciprofloxacin/dexamethasone over ofloxacin.