Intratympanic dexamethasone effective for treatment-resistant otitis media
MedWire News: Patients presenting with otitis media with effusion (OME) resistant to conventional therapy may benefit from intratympanic dexamethasone (ITD), suggest study findings.
"The intratympanic steroid injection is a simple drug delivery system that can specifically target various structures in the middle ear… aimed at reducing mucosal edema in the Eustachian tube and restoring tubal patency," say Mustafa Paksoy (Kartal Training and Research Hospital, Istanbul, Turkey) and co-authors.
The findings are of importance given that no method to date has been shown as effective for treating Eustachian tube pathology directly when conventional therapy fails.
In total, 41 patients (47 ears) with middle ear effusion resistant to conventional therapy were administered 0.5 ml (4 mg/ml) ITD directly into the antero-superior quadrant of the tympanic membrane using a 28-gauge needle. ITD injections were repeated once a week for 4 weeks without aspiration of the middle ear fluid. In addition, 23 patients (28 ears) who refused ITD were treated with oral antibiotics or local or systemic decongestants for 4 weeks.
Audiometric analysis 1 month post-treatment revealed significant improvements in air conduction (AC)-pure-tone average (PTA), bone conduction (BC)-PTA, and air-bone gap from baseline for patients who received ITD (15.17 dB, 5.25 dB, and 9.91 dB, respectively).
Conversely, patients receiving antibiotic treatment showed only 3.00-, 1.36-, and 2.00-dB improvements in AC-PTA, BC-PTA, and air-bone gap, respectively.
Evaluation of tympanometric results showed significantly better results for patients treated with ITD compared with those receiving antibiotics, with improvements seen in 55.6% versus 10.7% of patients, respectively.
Injections were well tolerated by patients and no persistent tympanic membrane perforation, sensorineural hearing loss, or complications occurred.
"ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic Eustachian tube dysfunction," write the authors in the Indian Journal of Otolaryngology and Head & Neck Surgery.
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By Ingrid Grasmo