Learning Objectives: Understand how knowledge of biofilms in otitis media may improve future treatments of otitis media.

Introduction: Otitis media with effusion (OME) is common, and at least a quarter of children require grommets more than once, with attendant risks. Better treatments would be welcome, especially if they obviate the need for repeat surgery, or avoid the requirement for anaesthesia and surgery altogether. Recent advances in our understanding of the importance of biofilms in otitis media pathogenesis have opened up potential new treatment avenues that could improve patient care in the future.

Methods: Review of the treatment of biofilms in otitis media.

Results: Treatment of biofilms requires antibiotic levels that are typically 100 to 1000 times higher than concentrations that inhibit free planktonic bacteria. Systemically administered antibiotics do not reach levels in the middle ear sufficiently high to eradicate biofilms (at least not without causing systemic toxicity). Ventilation tube insertion dries the middle ear and thus could supress biofilms, but it may not eradicate them, possibly accounting for the high rate of OME recurrence after VT extrusion. Biofilms in the middle ear could be eradicated by administering antibiotics directly to the middle ear, to reach an antibiotic level that is locally high enough to eradicate biofilms; drug delivery methods could include slow-release formulations placed surgically, or trans-tympanic delivery. Oral treatment strategies could also be useful, but rely on appropriate selection of antibiotics that work well against biofilms, perhaps potentiated by agents to disrupt biofilm matrix and middle ear mucus.

Conclusion: Better understanding of biofilms in otitis media has the potential to lead to development of better treatments in the future.