Summary: Westman et al. used the SwedEar register to investigate prophylactic antibiotics (PAs) in clean myringoplasty surgeries. The study of 1665 cases revealed no significant benefit of PAs on postoperative outcomes. Their findings challenge the traditional use of PAs in otolaryngology, emphasizing evidence-based medical decisions.

The Article: In otolaryngology, the use of prophylactic antibiotics (PAs) during clean myringoplasty surgeries is debated. While PAs are recognized for reducing postoperative infections in various surgeries, their benefit in clean myringoplasty is unclear, especially when considering concerns like antibiotic resistance. This ambiguity prompted Westman et al. to harness the SwedEar register, which covers 80% of all myringoplasties in Sweden between 2014-2019, to explore the advantages of using PAs in such surgeries.

Their retrospective study evaluated 1665 myringoplasties. The findings revealed that 11.2% of patients were given PAs. At a follow-up, 86.2% had healed tympanic membranes (TM). Among those administered PAs, 87.2% showed healed TM compared to 86.1% without PAs, a difference deemed statistically insignificant. Moreover, 8% experienced postoperative infections within 6 weeks, and this group had a 78.2% TM healing rate. Adults were more susceptible to infections than children. Crucially, there was no significant risk increase regarding TM reperforation or infections for those not given PAs.

In conclusion, Westman and team found no substantial benefits of PAs concerning post-myringoplasty outcomes. The study highlights that while PAs might be effective in some surgeries, their role in clean myringoplasty remains questionable. These insights could influence future otolaryngological practices, emphasizing the importance of evidence-based medical decision-making over conventional wisdom or tradition.

Expert comment: This pivotal study by Westman et al. underscores the need for evidence-based practices in otolaryngology. The findings from the SwedEar register challenge traditional beliefs about prophylactic antibiotics in clean myringoplasty, urging clinicians to re-evaluate and optimize patient care strategies in light of emerging evidence.

Prof. Dr. Prahlada N. B
01 January 2024

Reference / The full article can be accessed at the following links:

Westman, E,  Höglund, M,  Nilsson, FB,  Bonnard, Å,  Englund, E,  Eriksson, PO.  Prophylactic antibiotics has no benefit for outcome in clean myringoplasty—A register-based cohort study from SwedEar. Clinical Otolaryngology.  2023.

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