The effectiveness of nasal decongestants, oral decongestants and oral decongestant-antihistamines in the treatment of acute otitis media in children

Yıl 2009, Cilt: 19 Sayı: 6, 289 - 293, 12.12.2009

Ahmet Eyibilen İbrahim Aladağ Mehmet Güven Sema Koç Levent Gürbüzler

Öz

Objectives: The aim of this study was to evaluate the effectiveness of nasal decongestants, oral decongestants and oral decongestant-antihistamines in the treatment of acute otitis media and resolution of the middle ear effusion in children. Patients and Methods: 355 ears of 318 children [160 boys 179 ears and 158 girls 176 ears ] who were diagnosed to have acute otitis media and treated for it with different drug regimens were evaluated retrospectively regarding resolution of the middle ear fluid. 151 ears were treated with antibiotics and analgesics group 1 , 64 with antibiotics, nasal decongestants and analgesics group 2 , 81 with antibiotics, oral decongestants and analgesics group 3 , and 59 with antibiotics, oral decongestant-antihistamine combinations and analgesics group 4 . The children with middle ear effusion were followed up for three months. Results: Group 1, 2, 3 and 4 had persistent middle ear effusion and the presence of middle ear effusion was 27.2%, 18.8%, 25.9%, 28.8% at the 1st month and 5.8%, 0%, 0% and 5.9% at the end of the 3rd month, respectively. At the end of the third month, there was no significant difference between the groups regarding the resolution rates of the middle ear fluids in the antibiotic group and decongestants groups p>0.05 . Conclusion: We do not recommend the use of decongestants and antihistamines in the treatment of acute otitis media as they do not change the natural course of the disease.

Anahtar Kelimeler

Decongestants, nasal, middle ear, fluid/inflammation, respiratory tract infection

Çocuklarda akut otit media tedavisinde nazal dekonjestan, oral dekonjestan ve oral dekonjestan-antihistaminiklerin etkinliği

Öz

Amaç: Bu çalışmada çocuklarda akut otit media tedavisinde ve orta kulak efüzyonunun çözülmesinde nazal dekonjestan, oral dekonjestan ve oral dekonjestan-antihistaminik kombinasyonu içeren ilaçların etkinliği değerlendirildi.Hastalar ve Yöntemler: Akut otit media tanısı konan ve farklı ilaç uygulanarak tedavi edilen 318 çocuğun [160 erkek 179 kulağı and 158 kız 176 kulağı ] toplam 355 kulağı orta kulak sıvısının çözülmesine göre geriye dönük olarak incelendi. Kulakların 151’i yalnızca antibiyotik ve analjezik grup 1 , 64’ü antibiyotik analjezik ve nazal dekonjestanla grup 2 81’i antibiyotik, analjezik ve oral dekonjestanla grup 3 , 59’u ise antibiyotik, analjezik ve oral dekonjestan-antihistaminik kombinasyonu grup 4 içeren ilaçlarla tedavi edilmişlerdi. Orta kulak sıvısı olan çocuklar üç ay takip edildi.Bulgular: Grup 1, 2, 3 ve 4’de inatçı orta kulak sıvısı vardı ve orta kulak sıvısının varlığı birinci ayın sonunda gruplara göre sırasıyla %27.2, %18.8, %25.9 ve %28.8, üçüncü ayın sonunda ise sırasıyla %5.8, %0, %0 ve %5.9 idi. Üçüncü ayın sonunda orta kulak sıvısının çözülmesi açısından yalnızca antibiyotik kullanan ve ilaveten dekonjestanların verildiği gruplar arasında anlamlı bir fark yoktu p>0.05 .Sonuç: Akut otit media tedavisinde hastalığın doğal seyrinde herhangi bir değişikliğe neden olmadıkları için dekonjestan ve antihistaminik içeren ilaçların kullanılmasını önermiyoruz

Anahtar Kelimeler

Dekonjestan, nazal, orta kulak, sıvısı/enflamasyonu, solunum yolu enfeksiyonu

Kaynakça

• Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev 2003;16:230-41.
• Damoiseaux RA, Rovers MM, Van Balen FA, Hoes AW, de Melker RA. Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion. Fam Pract 2006;23:40-5.
• Flynn CA, Griffin GH, Schultz JK. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev 2004;(3):CD001727.
• Corbeel L. What is new in otitis media? Eur J Pediatr 2007;166:511-9.
• Heikkinen T, Ruuskanen O. Temporal development of acute otitis media during upper respiratory tract infection. Pediatr Infect Dis J 1994;13:659-61.
• Koivunen P, Kontiokari T, Niemelä M, Pokka T, Uhari M. Time to development of acute otitis media during an upper respiratory tract infection in children. Pediatr Infect Dis J 1999;18:303-5.
• van Heerbeek N, Ingels KJ, Zielhuis GA. No effect of a nasal decongestant on eustachian tube function in children with ventilation tubes. Laryngoscope 2002;112:1115-8.
• Jones AH. Why the increases in upper respiratory problems? Med Hypotheses 2001;57:378-81.
• Schnore SK, Sangster JF, Gerace TM, Bass MJ. Are antihistamine-decongestants of value in the treatment of acute otitis media in children? J Fam Pract 1986;22:39-43.
• Bhambhani K, Foulds DM, Swamy KN, Eldis FE, Fischel JE. Acute otitis media in children: are decongestants or antihistamines necessary? Ann Emerg Med 1983;12:13-6.
• Thomsen J, Mygind N, Meistrup-Larsen KI, Sørensen H, Vesterhauge S. Oral decongestant in acute otitis media. Results of a double-blind trial. Int J Pediatr Otorhinolaryngol 1979;1:103-8.
• Bluestone CD. Pathogenesis of otitis media: role of eustachian tube. Pediatr Infect Dis J 1996;15:281-91.
• Altman JS, Haupert MS, Hamaker RA, Belenky WM. Phenylephrine and the prevention of postoperative tympanostomy tube obstruction. Arch Otolaryngol Head Neck Surg 1998;124:1233-6.
• Davis SS, Eccles R. Nasal congestion: mechanisms, measurement and medications. Core information for the clinician. Clin Otolaryngol Allied Sci 2004;29:659-66.
• Chonmaitree T, Saeed K, Uchida T, Heikkinen T, Baldwin CD, Freeman DH Jr, et al. A randomized, placebo-controlled trial of the effect of antihistaminor corticosteroid treatment in acute otitis media. J
• Johnson D, Chandrasekhar SS, Mautone AJ. Intranasal phenylephrine-surfactant treatment is not beneficial in otitis media with effusion. Int J Pediatr Otorhinolaryngol 2008;72:1085-9.
• Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989;160:83-94.
• Birch L, Elbrønd O. A prospective epidemiological study of secretory otitis media in young children related to the indoor environment. ORL J Otorhinolaryngol Relat Spec 1987;49:253-8.
• Rosenfeld RM, Kay D. Natural history of untreatedotitis media. Laryngoscope 2003;113:1645-57.
• Hotomi M, Yamanaka N, Samukawa T, Suzumot M,Sakai A, Shimada J, et al. Treatment and outcome of severe and non-severe acute otitis media. Eur J Pediatr 2005;164:3-8.
• Renko M, Kontiokari T, Jounio-Ervasti K, Rantala H, Uhari M. Disappearance of middle ear effusion in acute otitis media monitored daily with tympanometry. Acta Paediatr 2006;95:359-63.