The efficacy of combining antibiotic treatment with topical intranasal steroid administration in the treatment of chronic otitis media with effusion

Yıl 2002, Cilt: 9 Sayı: 4, 257 - 262, 30.08.2002

Turgut Karlıdağ İrfan Kaygusuz Üzeyir Gök Şinasi Yalçın Erol Keleş Levent Öztürk

Öz

Objectives: We evaluated the efficacy of antibiotic treatment with or vvithout topical administration of intranasal budesonide in chronic otitis media with effusion OME .Patients and Methods: The study included 62 patients age range2to 12years with chronic OME. The patients were ran- domly assigned to three groups, namely, antibiotic treatment 20 patients, ampicillin/sulbactam, 25 mg/kg/daily , antibiotic treatment combined with intranasal budesonide 20 patients, 200 mg/daily , and no treatment 22 patients . Ali patients and families were questioned regarding the presence of allergy, frequent upper respiratory tract infections, passive smoking, low birth weight, and pre-school nursery attendance.Otoscopic examination findings and the results of tym- panograms obtained at the time of diagnosis, and at the end of four and eight weeks of treatment were evaluated.Results: At the end of eight weeks, significant improvement in tympanograms and otoscopic findings was obtained in both groups when compared with the control group p<0.05 .Resolution rates were 24% 9/37 ears , 39% 14/36 , and %5 2/40 with antibiotic, budesonide, and no treatment groups, respectively. Although budesonide treatment was associated with a higher rate of resolution of effusion compared to that of antibiotic alone, this did not reach significance p>0.05 .Conclusion: Further studies with larger patient series are required to better evaluate the efficacy of antibiotic treatment and topical intranasal steroid administration in chronic OME.

Anahtar Kelimeler

Administration, inhalation, ampicillin/therapeutic use, child, drug therapy, combination, middle ear ventilation, otitis media with effusion/drug therapy, pregnenediones/therapeutic use, steroids/therapeutic use, sulbactam

Efüzyonlu otitis media tedavisinde antibiyotik ile birlikte intranazal steroid kullanımının etkinliği

Öz

Amaç : Kronik efüzyonlu otitis media EOM tedavisinde, tekbaflına antibiyotik ve antibiyotik ile birlikte topikal intranazalbudesonid kullanımının etkinliği arafltırıldı.Hastalar ve Yöntemler: Çalıflmaya EOM tanısı almıfl,yaflları 2-12 arasında değiflen 62 hasta alındı. Hastalarrastgele üç gruba ayrıldı. Bir gruba antibiyotik 20 hasta,ampisilin/sulbaktam, 25 mg/kg , bir gruba antibiyotik ilebirlikte intranazal budesonid 20 hasta, 200 mcg/gün verilirken, kontrol grubu 22 hasta tedavisiz izlendi. Hastalarda ve ailelerinde alerji, sık üst solunum yolu enfeksiyonu geçirme, pasif sigara içiciliği, düflük doğum ağırlığı vekrefle gitme hikayesi sorgulandı. Kronik EOM tanısı konduğu andaki ve tedavinin dördüncü ve sekizinci haftalarındaki otoskopik muayene ve timpanogram sonuçları değ e r l e n d i r i l di.Bu l g u l a r : Sekiz haftalık tedavi sonrasında, her iki grubunotoskopik muayene ve timpanogram bulgularında kontrolgrubuna göre anlamlı düzelme görüldü p0.05 .Sonuç: Antibiyotik tedavisi ile birlikte topikal intranazal steroid kullanımının EOM tedavisindeki etkinliği daha geniflhasta serileriyle arafltırılmalıdır

Anahtar Kelimeler

Uygulama, inhalasyon, ampisilin/terapötik kullanım, çocuk, ilaç tedavisi, kombinasyon, orta kulak ventilasyonu, efüzyonlu otitis media/ilaç tedavisi, pregnenedion/terapötik kullanım, steroid/terapötik kullanım, sulbaktam

Kaynakça

• Akyıldız N. Kulak hastalıkları ve mikro c e r r a h i s i . Ankara: Bilimsel Tıp Yayınevi; 1998.
• Bluestone CD. Modern management of otitis media. Pediatr Clin North Am 1989;36:1371-87.
• Kline MW. Otitis media. In: Oski FA, DeAngelis CD, Feigin RD, editors. Principles and practice of pediatrics. 2nd ed. Philadelphia: JB Lippincott; 1990. p. 974-6.
• Beder E, Çuhruk Ç, Aktürk T, Gürsel O, Uzun KH, Öz- girgin N, ve ark. TED Ankara Koleji ilkokul öğrencile- ri arasında kulak-burun-boğaz hastalıkları prevalensi. Türk Otolarengoloji Bülteni 1979;4:250-7.
• Demireller A, Çuhruk Ç. 3-6 yaflları arasında seröz oti- tis media insidansı. Otorinolarengoloji ve Stomatoloji Dergisi 1988;2:15-8.
• Batman Ç, Üneri C, Tutkun A, fiehitoğlu MA, İnanlı S, Özer E, ve ark. İstanbul’da okul öncesi ve okul çağın- daki çocuklarda sekretuar otitis media prevalansı ve risk faktörleri. Türk Otolarengoloji Arflivi 2000;38:9-16.
• Paparella MM, Schachern P. New developments in treating otitis media. Ann Otol Rhinol Laryngol Suppl 1994;163:7-10.
• Handler SD, Magardino TM. Otitis media with eff u s i o n . In: Canalis FR, Lambert PR, editors. The ear. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 3 8 3 - 9 6 .
• Hızalan İ, Oğuz B. Efüzyonlı otitis media. Türkiye Klinikleri KBB Dergisi 2001;2:68-79.
• Berman S, Casselbrant ML, Chonmaitree T, Giebink GS, Grote JJ, Ingvarsson LB, et al. Recent advances in otitis media. 9. Treatment, complications, and seque- lae. Ann Otol Rhinol Laryngol Suppl 2002;188:102-24.
• Jung TT, Hanson JB. Classification of otitis media and surgical principles. Otolaryngol Clin North Am 1999; 32:369-83.
• Commins DJ, Koay BC, Bates GJ, Moore RA, Sleeman K, Mitchell B, et al. The role of Mucodyne in reducing the need for surgery in patients with persistent otitis media with effusion. Clin Otolaryngol 2000;25:274-9.
• Berman S, Grose K, Nuss R, Huber-Navin C, Roark R, G a b b a rd SA, et al. Management of chronic middle ear e ffusion with prednisone combined with trimethoprim- sulfamethoxazole. Pediatr Infect Dis J 1990;9:533-8.
• Göksu N, Ataoğlu H, Kemaloğlu YK, Ataoğlu Ö, Özsökmen D, Akyıldız N. Experimental otitis media induced by coagulase negative staphylococcus and its L-forms. Int J Pediatr Otorhinolaryngol 1996;37:201-16.
• Bluestone CD. Eustachian tube function: physiology, pathophysiology, and role of allergy in pathogenesis of otitis media. J Allergy Clin Immunol 1983;72:242-51.
• Skoner DP, Stillwagon PK, Casselbrandt ML, Tanner EP, Doyle WJ, Fireman P. Inflammatory mediators in chronic otitis media with effusion. Arch Otolaryngol Head Neck Surg 1988;114:1131-3.
• Daly K. Risk factors for otitis media sequelae and chronicity. Ann Otol Rhinol Laryngol Suppl 1994;163: 39-42.
• Tracy JM, Demain JG, Hoffman KM, Goetz DW. Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion. Ann Allergy Asthma Immunol 1998;80:198-206.
• B rook I, Yocum P. Quantitative bacterial cultures and beta-lactamase activity in chronic suppurative otitis media. Ann Otol Rhinol Laryngol 1989;98(4 Pt 1):293-7.
• Gök U, Bulut Y, Kelefl E, Yalçın S, Doymaz MZ. Bacteriological and PCR analysis of clinical material aspirated from otitis media with effusions. Int J Pediatr Otorhinolaryngol 2001;60:49-54.
• Daly K, Giebink GS, Batalden PB, Anderson RS, Le CT, L i n d g ren B. Resolution of otitis media with eff u s i o n with the use of a stepped treatment regimen of trimetho- prim-sulfamethoxazole and prednisone. Pediatr Infect Dis J 1991;10:500-6.
• Daly KA, Hunter LL, Giebink GS. Chronic otitis media with effusion. Pediatr Rev 1999;20:85-93.
• Cantekin EI, Mandel EM, Bluestone CD, Rockette HE, Paradise JL, Stool SE, et al. Lack of efficacy of a decon- gestant-antihistamine combination for otitis media with effusion (“secretory” otitis media) in children. Results of a double-blind, randomized trial. N Engl J Med 1983;308:297-301.
• Macknin ML, Jones PK. Oral dexamethasone for treat- ment of persistent middle ear effusion. Pediatrics 1985; 75:329-35.
• Giebink GS, Batalden PB, Le CT, Lassman FM, Buran DJ, Seltz AE. A controlled trial comparing three treat- ments for chronic otitis media with effusion. Pediatr Infect Dis J 1990;9:33-40.
• Schwartz RH, Puglese J, Schwartz DM. Use of a short course of prednisone for treating middle ear effusion. A double-blind crossover study. Ann Otol Rhinol Laryngol Suppl 1980;89(3 Pt 2):296-300.
• Mabry RL. Intranasal corticosteroids and cromolyn. Am J Otolaryngol 1993;14:295-300.
• Demain JG, Goetz DW. Pediatric adenoidal hypertro p h y and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995;95:355-64.
• Barnes PJ, Pedersen S. Efficacy and safety of inhaled corticosteroids in asthma. Report of a workshop held in Eze, France, October 1992. Am Rev Respir Dis 1993; 148(4 Pt 2):S1-26.
• Schwartz RH, Schwartz DM, Grundfast KM. Intranasal beclomethasone in the treatment of mid- dle ear effusion: a pilot study. Ann Allergy 1980;45: 2 8 4 - 7 .
• Lildholdt T, Kortholm B. Beclomethasone nasal spray in the treatment of middle-ear effusion -a double-blind study. Int J Pediatr Otorhinolaryngol 1982;4:133-7.
• S h a p i ro GG, Bierman CW, Furukawa CT, Pierson WE, Berman R, Donaldson J, et al. Treatment of persistent eustachian tube dysfunction in children with a e rosolized nasal dexamethasone phosphate versus placebo. Ann Allergy 1982;49:81-5.
• Butler CC, van Der Voort JH. Steroids for otitis media with effusion: a systematic re v i e w. Arch Pediatr Adolesc Med 2001;155:641-7.