N-acetylcysteine as an adjunct for refractory ear infections

Objective: To analyze the efficacy of Ciprodex otic augmented with N-acetylcysteine (NAC) against difficult ear infections. Subjects: Subjects were selected with at least I month of continuous otorrhea despite at least 3 distinct medical or surgical treatments. Interventions: Subjects received Ciprodex otic augmented with 0.5 or 2% NAC using standard dosing schemes. Main Outcome Measures: Serial audiometry and cessation of otorrhea by both history and binocular microscopy. Results: Seven subjects were included with an average of 18.4 months of continuous otorrhea despite aggressive therapy. Cessation of otorrhea was achieved in 6 of 7 subjects generally within 4 weeks of treatment. One of these 6 subjects remains on chronic suppressive therapy. The remaining subject failed because of persistent noncompliance. No subjects demonstrated ototoxicity via pretreatment and posttreatment audiometry. Conclusion: Ciprodex otic augmented with NAC seems to have considerable efficacy against otherwise refractory ear infections. This technique may prove to be a simple and powerful option for the treatment of difficult ear infections.