title: Assessing the efficacy of tragal pumping: a randomized controlled trial.
abstract: OBJECTIVE
  Tragal pumping is the practice of pushing on the tragus to raise pressure in the external auditory canal. This is a study to determine if tragal pumping improves middle ear penetration of ototopical medications via a patent pressure equalization tube.
  
  
  METHODS
  Prospective, randomized controlled trial.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Children with chronic otitis media scheduled for routine placement of bilateral pressure equalization tubes were offered enrollment in the study. After pressure equalization tube insertion, an otic preparation of 0.3% ofloxacin solution dyed with methylene blue was applied sequentially to both ear canals by the operating surgeon. Tragal pumping was performed on the experimental ear, and the opposite ear served as a control. A second operator, blinded to the randomization process, used an operating microscope to determine if otic drops had entered the middle ear as demonstrated by methylene blue staining of the promontory mucosa.
  
  
  RESULTS
  Twenty-four patients with a mean age of 3.6 years were enrolled in the study. Middle ear penetration of otic drops was present in 33% (8/24) of control ears and in 75% (18/24) of experimental ears, resulting in a statistically significant difference (P = .0094).
  
  
  CONCLUSIONS
  Tragal pumping improves the middle ear penetration of ototopical medications via a patent pressure equalization tube.
authors.affiliation: Department of Head & Neck Surgery, Kaiser Permanente Medical Center, Oakland, CA 94611, USA. nhboyd@gmail.com
authors.forename: Nathan H
authors.initials: NH
authors.lastname: Boyd
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Gottschall
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004311:Double-Blind Method; D004424:Ear Canal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D015242:Ofloxacin / Q000008:administration & dosage*; D010033:Otitis Media / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015242:Ofloxacin