The most commonly isolated organism of ear infection is Pseudomonas aeruginosa. In this paper, the authors searched the literature for peer-reviewed publications describing treatment protocols and used statistical analysis to evaluate bias, to assess outcome, and to determine the quality of evidence. The authors found 10 clinical trials (n = 162 patients) published between 1967 and 2006 that evaluated 13 treatment protocols. Seven studies were uncontrolled, and 3 were controlled but patients were not randomized to treatment groups. The authors concluded that evidence was insufficient to recommend for or against any one treatment protocol. The authors make a strong case that well-designed clinical trials are needed to evaluate the efficacy of treatment protocols for this ear disease.

COMMENTARY: It was surprising that only 10 studies met the criteria for inclusion given how common Pseudomonas ear infections are. Because of the required format of evidence-based reviews, many "case series" successes were not included. Peer-review was the limiting factor. During the 35-year period studied, topical therapy alone was the most popular approach, and several products are no longer on the market. There is excellent coverage of Pseudomonas ear infections in many review articles and current textbooks. The reader should not leave with the impression that recommendations in these (middle ear lavage, aggressive combined systemic and topical therapy) are ineffective, but rather are based on the authors' clinical experience.

Evidence-based veterinary dermatology: A systematic review of interventions for treatment of Pseudomonas otitis in dogs. Nuttall T, Cole LK. Vet Dermatol 18:69-77, 2007.