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.