***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Acute otitis media ( AOM ) in children with tympanostomy tubes in place typically presents with otorrhea ( draining ear ) . Because therapy is not st and ardized , various topical and systemic antibiotics of unproven efficacy and safety have been used in this indication . This study compared the safety and efficacy of ofloxacin otic solution , 0.3 % ( OFLX ) with that of Augmentin oral suspension ( AUG ) in pediatric subjects 1 - 12 years of age with tympanostomy tubes and acute purulent otorrhea . Subjects were r and omized to receive 10d of OFLX , 0.25 ml topically bid , or of AUG , 40 mg/kg per day .  Audiometry  was performed in subjects > or = 4 years of age . Overall cure rate for clinical ly evaluable subjects was 76 % with OFLX ( n = 140 ) and 69 % with AUG ( n = 146 ; P = 0.169 ) . Overall eradication rates for OFLX and AUG were similar for Streptococcus pneumoniae , Haemophilus influenzae and Moraxella catarrhalis and were superior with OFLX for Staphylococcus aureus and Pseudomonas aeruginosa ( P<0.05 for both ) . OFLX had a greater overall pathogen eradication rate ( 96 % vs. 67 % ; P<0.001 ) . Treatment-related adverse event rates were 31 % for AUG and 6 % for OFLX ( P<0.001 ) . Neither treatment significantly altered hearing acuity . Topical ofloxacin 0.3 % otic solution 0.25 ml bid was as effective and better tolerated than systemic therapy with Augmentin oral suspension 40 mg/kg per day in treating AOM in children with tympanostomy tubes BACKGROUND The objective benefits of tympanostomy tubes for otitis media are well established , but the subjective impact of surgery on child quality of life ( QOL ) has not been systematic ally studied . OBJECTIVES To determine the subjective impact of tympanostomy tubes on child QOL , and to compare the variability in QOL before surgery with that observed after surgery . DESIGN Prospect i ve , observational , before- and -after trial . SETTING Fourteen referral-based pediatric otolaryngology practice s in the United States . PATIENTS Consecutive ( 64 % ) and convenience ( 36 % ) sample of 248 children ( median age , 1.4 years ) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure . INTERVENTION Tympanostomy tubes were inserted as part of routine clinical care . Vali date d measures of QOL ( OM-6 survey ) , satisfaction with health care decision ( Satisfaction With Decision Scale ) , and satisfaction with office visit ;  surveys were completed at baseline ( visit 1 ) , at surgery ( visit 2 ) , and after surgery ( visit 3 ) . MAIN OUTCOME MEASURES Short-term changes in QOL before surgery ( visit 1 to visit 2 ) and after surgery ( visit 2 to visit 3 ) . RESULTS Changes in QOL before surgery were mostly trivial , and were smaller than changes observed after surgery ( P<.001 ) . Large , moderate , and small improvements in QOL occurred after surgery in 56 % , 15 % , and 8 % of children , respectively . Physical symptoms , caregiver concerns , emotional distress , and hearing loss were most improved , but significant changes were also seen for activity limitations and speech impairment . Trivial changes occurred in 17 % of children , and 4 % had poorer QOL . Predictors of poorer QOL were otorrhea 3 or more days ( 10 % of variance ) and decreased satisfaction with surgical decision ( 3 % of variance ) . Hearing status , child age , type of otitis media ( recurrent vs chronic ) , and office visit satisfaction were unrelated to outcome . CONCLUSIONS Tympanostomy tubes produce large short-term improvements in QOL for most children . The best outcomes occur when postoperative otorrhea is absent or minimal , and when parents are satisfied with their initial decision to have surgery . Further research is needed to document the long-term impact of tubes on child QOL BACKGROUND : Acute otorrhea is a common problem in children with tympanostomy tubes . We recently demonstrated that treatment with antibiotic-glucocorticoid eardrops is clinical ly superior to oral antibiotics and initial observation . The aim of this study was to assess the cost-effectiveness of these three common treatment strategies for this condition . METHODS : We performed an open-label pragmatic trial in which 230 children with acute uncomplicated tympanostomy-tube otorrhea were r and omly allocated to receive 1 of 3 treatments : hydrocortisone-bacitracin-colistin eardrops , oral amoxicillin-clavulanate suspension , and initial observation ( no assigned medication prescription to fill ) . Parents kept a daily diary capturing ear-related symptoms , health care re source use , and non – health care costs for 6 months . At 2 weeks and 6 months , the study doctor visited the children at home performing otoscopy . Using a societal perspective , treatment failure ( otoscopic presence of otorrhea at 2 weeks ) and number of days with otorrhea as reported in the daily diary were balanced against the costs . RESULTS : Antibiotic-glucocorticoid eardrops were clinical ly superior to oral antibiotics and initial observation both at 2 weeks and 6 months . At 2 weeks , mean total cost per patient was US$ 42.43 for antibiotic-glucocorticoid eardrops , US$ 70.60 for oral antibiotics , and US$ 82.03 for initial observation . At 6 months , mean total cost per patient was US$ 368.20 , US$ 420.73 , and US$ 640.44 , respectively . Because of the dominance of eardrops , calculating incremental cost-effectiveness ratios was redundant . CONCLUSIONS : Antibiotic-glucocorticoid eardrops are clinical ly superior and cost less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea OBJECTIVE To determine the efficacy and safety of topical ciprofloxacin/dexamethasone otic suspension compared with ofloxacin otic solution in the treatment of acute otitis media with otorrhea through tympanostomy tubes ( AOMT ) in pediatric patients . METHODS This multicenter , prospect i ve , r and omized , observer-masked , parallel-group study was conducted at 39 sites in 599 children aged > or=6 months to 12 years with an AOMT episode of < or=3 weeks ' duration . The mean age of patients was 2.5 years ( st and ard deviation : 2.37 years ) . Patients received either ciprofloxacin 0.3%/dexamethasone 0.1 % otic suspension 4 drops twice daily for 7 days or ofloxacin 0.3 % otic solution 5 drops twice daily for 10 days . Clinical signs and symptoms of AOMT were evaluated at clinic visits on days 1 ( baseline ) , 3 ( on therapy ) , 11 ( end of therapy ) , and 18 ( test of cure ) . A patient diary was used to measure time to cessation of otorrhea . Principal pretherapy pathogens included Streptococcus pneumoniae ( 16.8 % ) , Staphylococcus aureus ( 13.0 % ) , Pseudomonas aeruginosa ( 12.7 % ) , Haemophilus influenzae ( 12.4 % ) , S epidermidis ( 10.2 % ) , and Moraxella catarrhalis ( 4.1 % ) . RESULTS Ciprofloxacin/dexamethasone is superior to ofloxacin for clinical cure ( 90 % vs 78 % ) and microbiologic success ( 92 % vs 81.8 % ) at the test-of-cure visit , produces fewer treatment failures ( 4.4 % vs 14.1 % ) , and results in a shorter median time to cessation of otorrhea ( 4 days vs 6 days ) . Ciprofloxacin/dexamethasone treatment is also superior to improvement in clinical response by visit , absence of otorrhea by visit , and reduction of otorrhea volume by visit . Both topical otic preparations are safe and well tolerated in pediatric patients . No change in speech recognition threshold or decrease in hearing from baseline , based on audiometric testing , was noted with either regimen . CONCLUSION Topical ciprofloxacin/dexamethasone treatment is superior to topical ofloxacin in the treatment of AOMT OBJECTIVE To evaluate ciprofloxacin 0.3%/dexamethasone 0.1 % ( CIPRODEX , Alcon , Ft . Worth , TX ) for the prevention of early post-operative otorrhea following TT placement . METHODS This was a single-center , r and omized , evaluator-blinded , parallel-group study . Two hundred children undergoing bilateral TT placement were categorized as having unilateral ( " wet/dry " ) , bilateral ( " wet/wet " ) , or no ( " dry/dry " ) effusion at the time of surgery . All patients received Ciprodex or no treatment for 5 days post-operatively and returned at 2 weeks . RESULTS Physician-observed otorrhea was reported in 5 ( 4.95 % ) patients receiving Ciprodex and 39 ( 39.39 % ) patients receiving no treatment ( p<0.0001 ) . Treatment decreased otorrhea in all groups , while the greatest benefit was observed in patients with bilateral effusion ( 93 % reduction ) . Ciprodex treatment also decreased the rate of clinical ly diagnosed otitis media ( OM ) and effusion following TT placement ( p < or = 0.0006 ) . CONCLUSION Ciprodex reduced early post-operative otorrhea , clinical ly diagnosed OM and effusion following TT insertion . The greatest reduction in otorrhea was observed in patients with bilateral effusion at the time of surgery OBJECTIVE To determine the safety and efficacy of ofloxacin otic solution in the treatment of acute otorrhea in children with tympanostomy tubes . DESIGN Multicenter study with an open-label , prospect i ve ofloxacin arm and retrospective historical and current practice arms . SETTING Ear , nose , and throat pediatric and general practice clinics and office-based practice s. SUBJECTS Children younger than 12 years with acute purulent otorrhea of presumed bacterial origin and tympanostomy tubes . INTERVENTION Instillation of 0.3 % ofloxacin , 0.25 mL , twice daily for 10 days in the prospect i ve arm ; review of medical records in the retrospective arms . MAIN OUTCOME MEASURES The primary index of clinical efficacy was absence ( cure ) or presence ( failure ) of otorrhea at 10 to 14 days after therapy . The primary index of microbiologic efficacy ( in the ofloxacin arm only ) was eradication of pathogens isolated at baseline . Safety was evaluated in the ofloxacin arm only . RESULTS Significantly more clinical ly evaluable ofloxacin-treated subjects were cured ( 84.4 % ; 119/141 ) than were historical practice subjects ( 64.2 % ; 140/218 ) ( P < or = .001 ) or current practice subjects ( 70 % ; 33/47 ) ( P < or = .03 ) . All baseline pathogens were eradicated in 103 ( 96.3 % ) of 107 microbiologically evaluable ofloxacin subjects . Adverse events considered " possibly " or " probably " treatment related occurred in 29 ( 12.8 % ) of 226 ofloxacin-treated subjects . CONCLUSION Ofloxacin is safe and significantly more effective than treatments used in historical or current practice for acute purulent otorrhea in children with tympanostomy tubes OBJECTIVE The role of routine antimicrobial treatment of acute middle-ear infections is under debate , because the efficacy of antimicrobials in the resolution of middle-ear fluid has not been unambiguously proven . Acute tube otorrhea is regarded as evidence of acute otitis media , and for method ologic reasons it was chosen to provide objectivity for diagnostics and outcome assessment . The objective of this study was to assess whether amoxicillin-clavulanate accelerates the resolution of acute tube otorrhea . DESIGN AND SETTING R and omized , double-blind , placebo-controlled study in outpatient setting . PATIENTS Volunteer sample of basically healthy 6- to 72-month-old children with a tympanostomy tube . Eligibility required having acute tube otorrhea of < 48 hours ' of duration and no prior treatment within the last 2 weeks . The mean age of the participants was 25 months ; they had a history of 3 episodes of acute otitis media ( median ) , and 99 % had manifestations of a concomitant respiratory infection . Of 79 r and omized patients , 7 were withdrawn because of adverse events ; 66 patients completed the study . INTERVENTIONS Amoxicillin-clavulanate ( N = 34 ; 45 mg/kg/ 
    Output:
    
Adverse events occurred at similar rates in children treated with antibiotic eardrops and those treated with oral antibiotics , while no serious complications occurred in either of the groups .
We found moderate to low- quality evidence that antibiotic eardrops ( with or without corticosteroid ) are more effective than oral antibiotics , corticosteroid eardrops and no treatment in children with ear discharge occurring at least two weeks following grommet insertion .
There is some limited , inconclusive evidence that antibiotic eardrops are more effective than saline rinsing .
There is uncertainty whether antibiotic-corticosteroid eardrops are more effective than eardrops containing antibiotics only