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Can vinegar be used in treating

Pseudomonas ear infections in a
patient with a perforated eardrum?
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August 27, 2015 by Muhamed Aslam Khan, MS, MRCSEd; Nazneen Khan, MBBS, DGO,
DRCOG

Abstract
Chronic Pseudomonas ear infections are difficult to treat, particularly in
immunodeficient patients. Vinegar therapy is a time-tested measure for the
treatment of these infections. It is inexpensive, simple, easy to administer,
and very effective. However, some physicians are reluctant to use it in
immunocompromised patients or in the setting of a perforated tympanic
membrane. We describe our successful use of vinegar therapy in a
32-year-old man with both of these conditions. His Pseudomonas ear
infection had persisted for more than 5 years despite conventional drug
treatment. Eventually, we treated him with instillations of topical vinegar, and
his infection cleared in 3 weeks.

Introduction
CURRENT ISSUE
Chronic Pseudomonas infection of the ear in humans is difficult to treat,
especially in immunodeficient patients. This infection has remained resistant
to many modalities of treatment, leading to frustration for patients and
physicians alike. Pseudomonas organisms can be killed in an acidic
environment, which can be created with substances such as vinegar. 1-5

Vinegar has been used by veterinarians in the successful treatment of

Pseudomonas ear infections in canines. Similarly, it is well known that sterile
vinegar can be used in the treatment of human infections. 1-5 However, its
benefits are limited by the reluctance of some clinicians to use it in patients
who have a perforated eardrum. Moreover, the use of vinegar is discouraged
because it can cause a burning sensation in the ear.
September
In this article, we report the successful use of vinegar in treating a case of a 2017
chronic Pseudomonas ear infection in an immunocompromised patient who View Issues Archive
had a perforation of the tympanic membrane.
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Case report
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A 32-year-old man presented with intermittent high-grade fever, weight loss,

joint pains, complex partial seizures, and a perforation of the right eardrum,
which was associated with a loss of hearing and a serosanguineous WEBINARS &
discharge. Findings on audiometry were consistent with a right-sided hearing WHITEPAPERS
loss secondary to a tympanic membrane perforation (figure 1). The right ear
discharge revealed tuberculous bacilli on acid-fast bacilli staining. Aspirate Salivary Endoscopy
obtained from the affected joints was also positive for tuberculosis. Magnetic Applications and Advanced
resonance imaging of the brain detected lesions suggestive of multiple Techniques
tuberculomas, with a collection in the right mastoid cavity and middle ear. A
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Figure 1. At presentation, audiometry shows
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On the basis of all these findings, we diagnosed the patient with

disseminated tuberculosis. He was started on antituberculosis therapy along
with a corticosteroid and an antiepileptic. He underwent an urgent right
modified radical mastoidectomy to evacuate the collection in the mastoid
cavity, as well as to clear the granulation debris in the right middle ear. The
damaged ossicles had to be removed. A tympanoplasty was performed with
temporal fascia.

At 1 month postoperatively, the patient developed a perforation in the

tympanic membrane graft and a persistent serosanguineous discharge.
Microscopic examination of the fluid identified many gram-negative bacilli
and pus cells. No fungal hyphae or yeast cells were found. Culture and
sensitivity testing revealed that the patient had an acquired Pseudomonas
infection that was resistant to most of the cephalosporins, but sensitive to
most of the quinolones and aminoglycosides. Regular aural toilet and
various combinations of antibiotics were undertaken in addition to other
supportive measures, but since the patient was immunocompromised, the
infection persisted.

For the next 3 years, a corticosteroid had to be given on an intermittent basis

to control flare-ups of the paradoxical immune granuloma at the brain
tuberculoma sites. The patient remained on the antiepileptic agent. In view
of the severity of his presenting illness and the prolonged treatment with the
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Can vinegar be used in treating Pseudomonas ear infections in a patien... https://www.entjournal.com/article/can-vinegar-be-used-treating-pseu...
corticosteroid, there appeared to be no way to control the Pseudomonas ear
infection. Eventually, the patient lost the last remnant of hearing in his right
ear, and audiometry showed profound deafness (figure 2).

Figure 2. Five years after presentation,

audiometry shows the loss of the last
remnant of hearing in the right ear.

At that point, we tried treating the ear with a 2% vinegar solution. By then,
the severity and chronicity of the ear infection had led to exposure of the
chorda tympani and allowed the perforation of the tympanoplasty to persist.
The patient was made aware of the side effects of vinegar therapy, and he
provided informed consent prior to treatment.

The volume of the application was based on the size of the mastoid cavity,
which for our patient was approximately 0.25 ml; this volume was just
sufficient to smear the mastoid cavity and fill the inner one-third of the ear
canal. The vinegar was instilled into the right ear canal twice daily only under
strict observation, since this was not a conventional treatment and because
the patient had gross immunosuppression. The drops were left in situ for 15
minutes and then drained completely (dependent drainage). Then the pinna
was wiped with sterile cotton.

Therapy was continued for 3 weeks, and the ear infection cleared.
Examination of ear swabs confirmed eradication of the Pseudomonas
organisms. At that point, the patient developed an infection with Candida
albicans and Staphylococcus aureus, but it completely cleared in 5 days with
appropriate antibiotics.

Discussion
Chronic Pseudomonas ear infections remain a common clinical challenge to
practitioners in treating immunodeficient patients such as those with
diabetes, severe disseminated illness, malignancies, etc. Vinegar therapy is
a time-tested measure for the treatment of these infections. 1-5 It is
inexpensive, simple, easy to administer, and very effective. Its side effects
are negligible; a burning sensation is the most common, but it is generally
well tolerated by patients. The benefits of vinegar therapy far outweigh the

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Can vinegar be used in treating Pseudomonas ear infections in a patien... https://www.entjournal.com/article/can-vinegar-be-used-treating-pseu...
side effects, and clinicians should not be hesitant to use it in very severe or
chronic infections, especially in immunocompromised patients.

Our patient had an exposed chorda tympani and a perforation of the

eardrum, yet he did not develop any neurologic symptoms subsequent to the
vinegar treatment. Our patient did experience a profound hearing loss before
we instituted the vinegar treatment; perhaps this might have been prevented
if we had instituted vinegar therapy earlier.

In conclusion, we suggest that vinegar in the recommended clinical

concentration can be used with caution in patients with a perforated eardrum
and intact hearing.

References
1. Lang U. Minimal inhibitory concentration of natural vinegar and of
aluminium acetate-tartrate solution. Otol Neurol 2013; 34 (5): 795-7.
2. Washington E A. Instillation of 3% hydrogen peroxide or distilled vinegar
in urethral catheter drainage bag to decrease catheter-associated
bacteriuria. Biol Res Nurs 2001; 3 (2): 78-87.
3. Jung H H, Cho S D, Yoo C K ,et al. Vinegar treatment in the
management of granular myringitis. J Laryngol Otol 2002; 116 (3):
176-80.
4. Madhusudhan V L. Efficacy of 1% acetic acid in the treatment of chronic
wounds infected with Pseudomonas aeruginosa: Prospective
randomised controlled clinical trial. Int Wound J 2015 Apr. 8 [Epub ahead
of print].
5. Clayton M I, Osborne J E, Rutherford D, Rivron R P. A double-blind,
randomized, prospective trial of a topical antiseptic versus a topical
antibiotic in the treatment of otorrhoea. Clin Otolaryngol Allied Sci 1990;
15 (1): 7-10.

From the Department of General Practice, Al Ameen Hospital, Trichy, Tamil

Nadu, India.

Corresponding author: Dr. Muhamed Aslam Khan, Department of General

Practice, Al Ameen Hospital, 16/31 Anaikatti Maidan, Beema Nagar, Trichy,
Tamil Nadu, India 620001. Email: aslamneenu@gmail.com

Ear Nose Throat J. 2015 August;94(8):E52

Topics
OTOLOGY MIDDLE EAR OTITIS

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