Glacial Acetic Acid may help Manage Chronic Otitis Media, Suggests Study

Pre-surgical management of mucosal Chronic Otitis Media (COM) requires a dry ear for 8–12 weeks, yet antibiotic-resistant biofilms often cause persistent discharge that delays tympanoplasty. To address this clinical gap, Dr. Amit Saini and colleagues at Dr. Rajender Prasad Government Medical College evaluated 2% Glacial Acetic Acid (GAA) irrigation as a tool to disrupt these microbial matrices, aiming to accelerate recovery and reduce reliance on systemic antibiotics.

Therefore, in the tertiary-center randomized trial, 100 patients with persistent mucosal chronic otitis media (COM) discharge (>4 weeks) were randomized to receive culture-specific oral antibiotics combined with alternate-day aural irrigation using either 2% glacial acetic acid (GAA) at body temperature or normal saline. Patients with systemic comorbidities or recent antibiotic exposure were excluded to ensure study integrity. The primary endpoint was clinical resolution, determined by a standardized score assessing otoscopic findings and patient symptoms.

Key Clinical Findings of the Study Includes:

• Rapid Symptom Resolution: Patients in the GAA cohort reached their treatment endpoints significantly faster, requiring only 6.48 ± 1.83 days compared to the 11.12 ± 1.98 days needed by the saline group.

• Targeting Resistant Pathogens: The intervention proved highly effective against common isolates like Pseudomonas aeruginosa and Staphylococcus aureus, which were the predominant organisms identified in the study's cultures.

• Biofilm Matrix Penetration: Research within the study emphasized that GAA’s unique ability to infiltrate the extracellular polymeric substance matrix allows it to eliminate bacterial cells that typically survive systemic drug therapy.

• Safety and Tolerability: Notably, no adverse effects were reported by any participants during the aural syringing process, confirming the safety of this bedside procedure.

• Reduced Antibiotic Burden: By dramatically shortening the period of active ear discharge, the study demonstrated that GAA irrigation facilitates a significant reduction in the total duration of oral antibiotic treatment.

The results suggest that incorporating 2% GAA irrigation into the standard care for mucosal COM can reduce the symptomatic period by approximately five days compared to saline irrigation. This faster resolution not only improves patient comfort but also helps in preparing the middle ear for definitive surgical management more efficiently.

Thus, the study concludes clinicians may consider integrating GAA aural irrigation as a practical adjunctive tool to enhance recovery rates and support global stewardship efforts by minimizing the systemic antibiotic burden in patients with discharging ears.

While these results are promising, the study was limited by its sample size and the use of concurrent oral antibiotics, indicating a need for future large-scale trials to explore the potential of GAA irrigation as a standalone monotherapy.

Reference

Kumar V, Saroch MK, Saini A, Singh V, Raina SK. Role of glacial acetic acid irrigation in reducing oral antibiotic use in chronic otitis media: A prospective randomized controlled trial. Indian J Otol 2026;32:121-3.