A randomised clinical trial of single or extended dosing ciprofloxacin versus no intervention for prevention of ventilation tube otorrhoea and obstruction (PreVenTO2).

OBJECTIVES: To determine the effectiveness of ciprofloxacin .3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. DESIGN: Three-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1: 1: 1 ratio to single intraoperative application of ciprofloxacin drops, extended 5 day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. SETTING: The study was conducted in a large tertiary health network in Melbourne, Australia. PARTICIPANTS: All children, 17 years and under, undergoing bilateral middle ear ventilation tube surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. MAIN OUTCOME MEASURES: Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. RESULTS: Two-hundred and fifty-six paediatric patients completed the study with a median age of 4.02 years. One-hundred and fifty-three participants were male. Ear analysis (n = 512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR = .341, 95% CI .158-.738, NNT =11.25, p = .006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR = .424, 95% CI .193 to .930, NNT =14.7, p = .032). CONCLUSION: Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea, and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.

The effect of vocal function exercises on the voices of aging community choral singers.

BACKGROUND: The human voice undergoes changes associated with normal physiological aging after the age of approximately 65 years. These voice changes indicate an overall decline in vocal function, which can have diverse vocal and psychosocial impacts for the aging individual. At present, there is limited evidence as to whether vocal exercise can alleviate negative vocal changes arising from physiological aging, in particular for aging individuals who sing. OBJECTIVES: The aim of this study was to investigate the effectiveness of a 5-week Vocal Function Exercise (VFE) program on measures of vocal function in a sample of aging community choral singers. STUDY DESIGN: Prospective quasi-experimental design. METHODS: A group of 22 aging community choral singers (eight men and 14 women) were randomly assigned to either the VFE program or control group. Pretraining and posttraining comparisons were made of auditory-perceptual, aerodynamic, acoustic, and self-evaluation voice measures. RESULTS: After VFE training, significant improvements in perceived roughness, maximum phonation time, jitter, shimmer, and noise-to-harmonics ratio were found for participants in the VFE group. However, evaluations of perceived breathiness and strain and phonational frequency range did not reveal significant changes. The VFE program was also generally perceived by the participants to have a positive effect on their voices. CONCLUSIONS: The results of this preliminary study suggest that VFE has the potential to mitigate the effects of physiological vocal aging and deserves further research attention as a mode of vocal training for aging individuals, particularly for those who sing.