Stop the Leak! Simple Solutions to Recurrent-Chronic Draining Ear

PROGRAM DESCRIPTION: Chronic otorrhea is one of the most common yet vexing and challenging clinical problems facing otolaryngologists and
advanced practice providers. This expert series provides a culmination of 30 years of basic science and clinical
research alongside ample clinical experience. Using an interactive format in a case-oriented approach, the series will
review state-of-the-art evidence regarding medical treatment, antibiotic stewardship applied to this specific entity, both
infectious and non-infectious etiologies of chronic otorrhea and will specifically address modern day challenges with
resistant bacterial pathogens causing otorrhea such as MRSA and atypical pathogens such as yeast and molds. Less
commonly recognized entities such as allergic chronic otorrhea and chronic otorrhea resulting from obscure etiologies
such as a dermatitic ID reaction will be discussed in detail and will illustrate that "all draining ears are not infectious."
The quagmire of when to operate, on whom to operate, and which surgery alone or in combination from tympanostomy
tube removal or replacement, tympanoplasty with or without mastoidectomy, and adenoidectomy will be outlined in a
practical and patient-centered decision tree. An evidence-based best practice clinical pathway along with a validated
nurse phone triage algorithm will be presented in a way that can be implemented into your practice tomorrow. Vaccines
which may be helpful in some cases will be reviewed and future directions in research relating to biofilm, bacterial
substitution, bacterial inhibition and probiotic establishment of normal physiologic homeostasis of the middle ear and
external auditory canal will be promoted as a framework and ultimate goal to achieve in this difficult cohort of patients.

OUTCOME OBJECTIVE 1: Implement state-of-the-art evidence regarding diagnosis, medical treatment, and surgical treatment of chronic otorrhea

OUTCOME OBJECTIVE 2: Analyze modern day challenges with resistant bacterial etiologies such as MRSA and atypical pathogens such as yeast & mold

OUTCOME OBJECTIVE 3: Implement a chronic otorrhea evidence-based best practice clinical pathway and a validated nurse phone triage algorithm

BACKGROUND STATEMENT: Every otolaryngologist confronts challenging cases of recurrent or chronic otorrhea. Expert series such as this are critical not to introduce novel procedures for treatment, but rather to summarize the evidence and crystallize it into a practical, evidence-based best practice pathway.

Comprehensive Otolaryngology Track Statement : As a pediatric otolaryngologist practicing in a tertiary referral center, most of my patient referrals are from community comprehensive otolaryngologists. This lecture expands the treatment arsenal of the comprehensive otolaryngologist for in the front line of ENT care.