***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: OBJECTIVES To compare different treatment regimens of  chronic suppurative otitis media ( CSOM ) in school children , in regard to their consequence in hearing and discharge from the ear drum perforation . DESIGN R and omised controlled trial . SETTING R and omly selected primary schools within Dar es Salaam . SUBJECTS Three hundred and twenty eight children between 5 - 17 years of age with CSOM in one or both ears . RESULTS Three to four months after the onset of treatment 31 % of group 1 , 54 % of group 2 , and 56 % of group 3 , had dry ears . Treatment with dry mopping and boric acid in alcohol ear drops  was significantly better than dry mopping alone . Adding amoxicillin to the treatment did not improve the end results . Hearing test performed before and after treatment showed that the hearing thresholds were the same or better after the treatment . The possible risk that boric acid in alcohol ear drops should lead to sensorineural hearing loss has not been confirmed . CONCLUSION Based on the above results , the treatment of choice for CSOM in children in Dar es Salaam should be dry mopping and boric acid in spirit ear drops A double-blind controlled trial of cefroxadine ( CXD ) 250 mg t.i.d . was undertaken to objective ly evaluate its safety and effectiveness in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media , using cephalexin ( CEX ) 250 mg q.i.d . as a control drug , and the following results were obtained . In the treatment of acute suppurative otitis media , the 2 drugs produced almost equal outcomes , showing no significant difference in assessment s of both overall effects and usefulness . In the treatment of acute exacerbation of chronic suppurative otitis media , the 2 drugs exhibited no significant difference as well in overall effects by Wilcoxon 's two- sample test . However , the CEX group had significantly more nonresponsive patients , i.e. 35.5 % as compared with 9.7 % of the CXD group ( chi 2-test , P less than 0.05 ) . In the assessment of clinical usefulness as well , no significant difference was observed between the 2 groups . In the assessment of overall effects based on the patients whose isolated organisms were sensitive to the drugs , CEX group had more patients not responding to the treatment of acute exacerbation of chronic suppurative otitis media ( chi 2-test , P less than 0.05 ) . Bacteriological effects were not significantly different between the 2 drugs in both acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media . Overall safety rating was not significantly different between the 2 drugs . Side effects occurred as the symptoms of digestive organ in 2 patients each in both groups ( equally an incidence of 2.6 % ) . As for the improvement of each symptom after treatment ( assessed on day 3 ) , CXD was superior in the improvement rate of otorrhea volume as the main symptom of acute exacerbation of chronic suppurative otitis media , while CEX was superior in that of otoobstruction feeling . From the above findings , it is presumed that CXD is a safe drug which can exhibit equal or superior therapeutic effects to CEX in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media , at 3/4 of the CEX dose level Background Chronic suppurative otitis media ( CSOM ) is frequently associated with symptoms of inflammation like discharge from the ear or pain . In many cases , patients suffer from hearing loss causing communication problems and social withdrawal . The objective of this work was to collect prospect i ve audiological data and data on general and disease-specific quality of life with vali date d quality of life measurement instruments to assess the impact of the disease on health-related quality of life ( HR-QOL ) . Methods 121 patients were included in the study . Patients were clinical ly examined in the hospital before and 6 months after surgery including audiological testing . They filled in the quality of life question naires SF-36 and Chronic Otitis Media Outcome Test 15 ( COMOT-15 ) pre-operatively and 6 and 12 months post-operatively , respectively . Results Complete data records from 90 patients were available for statistical analysis . Disease-specific HR-QOL in patients with CSOM improved after tympanoplasty in all the scales of the COMOT-15 . There was no difference in HR-QOL assessment between patients with mesotympanic respectively epitympanic CSOM . However , we did find the outcome to be worse in patients who received revision surgery compared with those receiving primary surgery . Audiometric findings correlated very well with the subscale hearing function from the COMOT-15 question naire . General HR-QOL measured with the SF-36 was not significantly changed by tympanoplasty . Conclusions Tympanoplasty did lead to a significant improvement of disease-specific HR-QOL in patients with CSOM while general HR-QOL did not change . Very well correlations were found between the subscale hearing function from the COMOT-15 question naire and audiological findings . Revision surgery seems to be a predictor for a worse outcome We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients ( 95 ears ) with otorrhea due to chronic suppurative otitis media in two treatment setting s. One group ( n=40 ; 47 ears ) received daily ciprofloxacin therapy plus aspiration in the clinic . The other group ( n=40 ; 48 ears ) self-administered ciprofloxacin at home . Overall , otorrhea resolved in 88 % of all ears within 12 days of the initiation of treatment . The clinic-treated patients tended to respond more rapidly than did the self-treated patients , but there was no statistically significant difference in success rates between the two groups . Side effects were negligible . We conclude that empiric topical ciprofloxacin therapy is an effective , safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media An open multicentre study was conducted in 484 children between the ages of 6 months and 12 years with otitis media to compare the efficacy , the safety and the tolerance of once-daily azithromycin given for three days versus thrice-daily amoxicillin/clavulanic acid ( CA ) given for ten days . A satisfactory response ( cure plus improvement ) was noted 10 to 14 days after the start of treatment in 199 of 215 ( 92.6 % ) azithromycin-treated children and in 186 of 198 ( 93.9 % ) amoxicillin/CA-treated children . The relationship between treatment and clinical response was independent of chronicity of infection and the presence or absence of a perforated eardrum . Improvement in signs and symptoms of otitis media occurred significantly more rapidly in the children treated with azithromycin . Treatment-related or possibly treatment-related adverse events were recorded in 11 of 243 ( 4.5 % ) azithromycin-treated patients and in 20 of 240 ( 8.3 % ) treated with amoxicillin/CA . No patients in the azithromycin treatment group were withdrawn from treatment , but six amoxicillin/CA patients , including two < 2 years of age , discontinued treatment prematurely because of adverse events ; the difference between treatment groups was statistically significant ( p=0.0146 ) . It is concluded that azithromycin given as an oral suspension once daily for three days is as safe and effective as amoxicillin/CA given thrice daily for ten days in the treatment of children with otitis media Objective To determine the efficacy of Burow 's solution as an otologic preparation for the treatment of  chronic ear infection .  Study Design Two studies were included : 1 ) a prospect i ve clinical study and 2 ) a laboratory study on antibacterial and antifungal effects . Setting A private otology practice and a laboratory study . Patients Fifty-eight patients with refractory otorrhea . Intervention Diagnosis by otoscopy , audiometry , and bacteriology . Methods Burow 's solution was mixed in solutions with four organisms : methicillin-resistant Staphylococcus aureus , penicillin-resistant Streptococcus pneumoniae , C and ida albicans , and Aspergillus . Soon after Burow 's solution was mixed in the solutions with organisms , and 5 , 10 , and 20 minutes thereafter , the mixtures were cultured on agars . The numbers of the bacterial or fungal colonies were counted to evaluate the effect of Burow 's solution . Main Outcome Measures Changes in the clinical findings of the ears , the symptom of otorrhea , and side effects were assessed . Results Thirty-five ( 70 % ) of the 50 ears assessed were “ cured ” and 10 ( 20 % ) ears assessed were “ improved . ” No significant side effect was observed . Regarding the laboratory study , the four organisms disappeared within 20 minutes after Burow 's solution was mixed . Conclusion Burow 's solution was considered to be an effective otologic preparation OBJECTIVE To evaluate the efficacy of ciprofloxacin compared with tobramycin and placebo ear drops in the treatment of chronic suppurative otitis media without cholesteatoma . DESIGN Sixty ears ( in 51 patients ) were r and omly divided into 3 treatment groups : ciprofloxacin hydrochloride , tobramycin , and placebo interventions . SETTING The otolaryngology department of a university teaching hospital . INTERVENTION All ears were treated topically for 3 weeks . MAIN OUTCOME MEASURES Each patient received a small , numbered bottle and was instructed to instill 5 drops 3 times daily for 3 weeks . The final clinical and bacteriologic assessment was made after 3 weeks . RESULTS The organism most commonly isolated from the ear discharge was Pseudomonas aeruginosa . Its sensitivity to ciprofloxacin and tobramycin was 94.2 % and 70.6 % , respectively . The clinical response was 78.9 % , 72.2 % , and 41.2 % in the ciprofloxacin , tobramycin , and placebo groups , respectively . The bacteriologic response rate was 66.7 % for the ciprofloxacin and tobramycin groups and 20 % for the placebo group . Treatment with ciprofloxacin ear drops seemed to be as effective as treatment with tobramycin . CONCLUSION While the lack of ototoxicity of ciprofloxacin was not tested in our study , this treatment may be considered as a potential topical therapy for cases of chronic suppurative otitis media Abstract Chronic otitis media is persistent and insidious disease . It is one of the most common bacterial infections in the field of otolaryngology having significant economic and individual repercussion . Medical management of chronic suppurative otitis media ( CSOM ) for dry ear is essential before surgical treatment . The objective is to consider the most appropriate medical treatment modalities for patients of CSOM . To assess results of acetic acid irrigation and topical and systemic antibiotic in CSOM and consider , the most appropriate medical management . This study was conducted prospect ively from Nov 2011 to Sep 2013 in 100 patients of CSOM ( tubotympanic type ) . Patient included in the present study were divided in two groups . In one group patients were treated with aural toilet and irrigation with acetic acid and in other group patients were treated with topical and systemic antibiotic . After a follow up period of 3 months duration results were assessed on the basis of absence of discharge , healing of perforation and status of middle ear . Otorrhoea resolution in group treated with acetic acid was 84 % and healing of perforation was noted in 26 % while failure rate of 16 % was noted . In group treated with topical and systemic antibiotic 58 % of patient shows otorrhoea resolution , 14 % achieve healing of perforation and 32 % had failure . Medical management of CSOM without Cholesteatoma by frequent aural cleaning and irrigation using dilute acetic acid can be more desirable choice as compared to the topical and oral antibiotics A total of 102 children with recurrent otitis media or therapeutic failure after treatment with phenoxymethyl penicillin  were entered into a double-blind study with parallel groups , comparing treatment with amoxycillin/clavulanate suspension ( Spektramox ) for 7 days with amoxycillin suspension ( Imacillin ) for 10 days . Bacterial and clinical investigations were performed . A total of 91 patients were evaluated for efficacy at the first follow-up visit ( 10 - 12 days after start of treatment ) . Amoxycillin/clavulanate and amoxycillin showed equally high , satisfactory treatment results , i.e. more than a 90 % response . Similarly , there was no statistically significant difference between the treatment groups at the second follow-up visit ( about 30 days after start of treatment ) . Bacteriological cultures from the nasopharynx showed equal distribution of Haemophilus influenzae , Branhamella catarrhalis and Streptococcus pneumoniae between the study groups . Elimination of the initially occurring pathogens was equal in the two study groups with the exception of B. catarrhalis which was eliminated to a significantly higher extent with amoxycillin/clavulanate . Both drugs were well tolerated . In patients with recurrent otitis media or therapeutic failure , treatment with amoxycillin/clavulanate for 7 days results in high , satisfactory clinical effects and is comparable to treatment with amoxycillin for 10 days Methicillin-resistant Staphylococcus 
    Output:
    
However , amongst this uncertainty there is some evidence to suggest that the use of topical antibiotics may be effective when compared to placebo , or when used in addition to a systemic antibiotic .
There is also uncertainty about the relative effectiveness of different types of antibiotics ; it is not possible to determine with any certainty whether or not quinolones are better or worse than aminoglycosides .
In general , adverse effects were poorly reported