title: Perioperative only versus extended antimicrobial usage in tympanomastoid surgery: a randomized trial.
abstract: OBJECTIVE
  Antimicrobial prophylaxis is still a matter of debate in ear surgeries. Previous studies have focused on prophylaxis in middle ear surgery alone without inclusion of mastoidectomy. We therefore investigated efficacy of two regimes of antimicrobial prophylaxis in tympanoplasty with cortical mastoidectomy done for mild middle ear disease in chronic otitis media.
  
  
  METHODS
  Prospective, randomized, controlled, double-blind study.
  
  
  METHODS
  Patients undergoing tympanoplasty with cortical mastoidectomy were included and randomized into two study groups. The group I patients received parenteral perioperative antimicrobials; only group II patients received additional extended oral antimicrobials for 8 days more postoperatively. Primary outcomes evaluated were postaural wound infection and graft success, assessed weekly until 1 month. Adverse events and length of hospital stay were evaluated as secondary outcome.
  
  
  RESULTS
  Seventy-eight patients were randomized into group I (n = 39) and group II (n = 39). The two groups showed no difference in wound infection rate. The graft success rate in both the group was comparable (94.87% in group I and 97.44% in group II, respectively; P = 1.00). The length of hospital stay was significantly longer (P = 0.00001) in group II (3.05 [0.72], mean [SD]) as compared to group I (2.36 [0.49]). During the first postoperative week, a significantly higher incidence of gastrointestinal disturbances were observed in group II (19 [48.72%] as compared to 1 [2.56%] in group I, P = 0.00001).
  
  
  CONCLUSIONS
  The present study shows that there is no need of extended antimicrobial prophylaxis for tympanoplasty with cortical mastoidectomy done for mild middle ear disease. An indiscriminate use of antimicrobials may lead to increase incidence of adverse events and prolonged hospital stay.
  
  
  METHODS
  1b.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India.
authors.forename: Vijay G
authors.initials: VG
authors.lastname: Bidkar
authors.forename: Roshan R
authors.initials: RR
authors.lastname: Jalisatigi
authors.forename: Ashok S
authors.initials: AS
authors.lastname: Naik
authors.forename: Raghunath D
authors.initials: RD
authors.lastname: Shanbag
authors.forename: Rashmi
authors.initials: R
authors.lastname: Siddappa
authors.forename: Poorvi V
authors.initials: PV
authors.lastname: Sharma
authors.forename: Harihar V
authors.initials: HV
authors.lastname: Hegde
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008417:Mastoiditis / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D061646:Operative Time; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000175:diagnosis / Q000601:surgery; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Prophylaxis; otitis media; surgical wound infection; tympanoplasty