About 2 per cent of adults have active chronic otitis media, the majority being managed by medical means. Previous controlled studies have been unable to show benefit from any medication, including systemic or topical antibiotics, but the effect of the addition of topical steroids to the latter has never been evaluated.

One hundred and sixty three adults with active chronic otitis media were randomly allocated to receive either antibiotic/steroid ear drops or placebo therapy over a 4–6 week period. Fifty-two per cent of ears receiving active therapy, as opposed to 30 per cent on placebo therapy (p<0.05), became otoscopically inactive if compliance to medication was greater than 70 per cent. However, when there was an open mastoid cavity, active therapy was no more successful than placebo. Though gentamicin was the antibiotic used, there was no evidence of ototoxic inner ear damage.

Surprisingly, correlation between clinical activity and patient report of a discharge was poor. Forty percent of both treatment groups considered that their ear had become dry following therapy and these were not the same patients whose ears had become otoscopically inactive.