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A topical steroid without an antibiotic cures external otitis efficiently: a study in an animal model.
Umeå University, Faculty of Medicine, Clinical Sciences.
Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
2001 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 258, no 6, 287-291 p.Article in journal (Refereed) Published
Abstract [en]

In an animal external otitis model, inflammatory reactions were evoked by mechanical stimulation of the rat ear canal skin. The rats were in four groups: group A treated with a group III steroid, betamethasone dipropionate; group B treated with hydrocortisone combined with oxytetracycline; group C treated with hydrocortisone with oxytetracycline and polymyxin B added; Group D, the controls, treated with saline. All rats were observed otomicroscopically daily during the first 7 days after treatment and then on days 10 and 20. A standardized scoring system was used to evaluate colour, swelling and effusion of the ear canal. Histological specimens were collected on days 3, 7, 10 and 20. The most rapid improvement in the ear canal status occurred in the animals treated with betamethasone dipropionate. The inflammatory reaction of the ear canal skin caused by mechanical stimulation was characterized by oedema of the stroma but few inflammatory cells were present. The surface of the epithelium towards the connective tissue layer was smooth in the group III-treated animals (group A) whereas other groups had irregularities of the basal membrane. From this study it is inferred that the group III steroid betamethasone dipropionate alone heals experimentally induced external otitis more rapidly than hydrocortisone with oxytetracycline, with or without polymyxin B. These findings should be considered in future clinical trials of external otitis.

Place, publisher, year, edition, pages
2001. Vol. 258, no 6, 287-291 p.
Keyword [en]
External otitis, Ear canal skin, Betamethasone dipropionate, Animal model
Identifiers
URN: urn:nbn:se:umu:diva-27111DOI: 10.1007/s004050100332PubMedID: 11583468OAI: oai:DiVA.org:umu-27111DiVA: diva2:276205
Available from: 2009-11-11 Created: 2009-11-11 Last updated: 2017-12-12
In thesis
1. External otitis and its treatment: is a group III steroid without antibiotics sufficent therapy? Experimental and clinical studies
Open this publication in new window or tab >>External otitis and its treatment: is a group III steroid without antibiotics sufficent therapy? Experimental and clinical studies
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

ABSTRACT

External otitis and its treatment. Is a group III steroid without antibiotics sufficient therapy? – Experimental and clinical studies

Per Emgård, Department of Otorhinolaryngology, University of Umeå and Ystad Hospital, Umeå and Ystad, Sweden

External otitis is one of the most common ear, nose and throat (ENT) diagnoses in out-patient clinics. The clinical course of external otitis includes itching, pain, redness, swelling and effusion of the external auditory canal (EAC) with normal tympanic membrane status. The inflammatory condition is often associated with infection by bacteria, e.g. Pseudomonas aeruginosa, or skin bacteria such as Staphylococcus species. Fungi are present only in a low percentage of cases and if present Candida albicans infection is the most frequent in northern countries such as Sweden and the UK. Topical therapy is recommended in most countries and dominates the therapy in most studies. Topical drugs used are usually a combination of antibiotics and a steroid. However, external otitis is treated with surprisingly many strategies – eleven different ones in Sweden, for example, and 18 in the UK.

The aims of the present studies were to –

-establish an animal model, infected and uninfected, suitable for testing various treatment strategies of external otitis; and

-perform a clinical study in patients to elucidate whether a group III steroid alone is as efficient for treatment of external otitis as is the commonly used topical drug containing a combination of a steroid and antibiotics.

The animal model was established through mechanical irritation of the external ear canal skin of Sprague-Dawley rats. An evaluation scale for characterization of the clinical status of the ear canal was introduced, recording redness, swelling and occurrence of effusion in a standardized way. Specimens of the ear canal skin were analysed by histological techniques. A topical solution of 0.05% bethametasone dipropionate (BD) was compared with a 1% hydrocortisone solution with antibiotics oxytetracycline and polymyxin B added (HCPB), administered in the external otitis model infected or non-infected with bacteria (P. aeruginosa) and a fungus (C. albicans).

The same drugs were tested in a randomized parallel-group multi-centre study in 51 patients. The clinical status of the external otitis patients was evaluated on a similar scale as used in the animal model. Early normalization of the ear canal skin status and frequency of relapses during the 6-month follow-up period were used as end-points of the study.

The studies showed the following:

-An animal model for external otitis, infected or uninfected, could be established.

-A new scale for evaluation of the external ear canal status with regard to redness, swelling and occurrence of effusion was introduced for the animal model as well as for the investigations in patients.

-Treatment with a group III steroid topical solution without antibiotics was superior to treatment with a group I steroid with antibiotics added in achieving resolution of external otitis.

-The effectiveness of the topical drugs in the clinical studies in external otitis patients was similar to that in animal external otitis models.

We conclude that a group III steroid solution cures external otitis more effectively than does a solution containing a group I steroid combined with antibiotics, whether infected by bacteria or by fungi. No difference was evident regarding adverse effects. Furthermore, costs favour a solution without any antibiotic components. In view of these observations a group III steroid solution is preferred for remedy of external otitis in the clinical situation.

Key words: external otitis, external auditory canal (EAC), animal model, treatment, betamethasone, hydrocortisone, antibiotics, human study, Pseudomonas aeruginosa, Candida albicans.

Place, publisher, year, edition, pages
Umeå: Klinisk vetenskap, 2005. 87 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 988
Keyword
Medicine, external otitis, external auditory canal (EAC), animal model, treatment, betamethasone, hydrocortisone, antibiotics, human study, Pseudomonas aeruginosa, Candida albicans., Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-607 (URN)91-7305-953-6 (ISBN)
Public defence
2005-10-27, sal b (rosa salen, 9tr), tandläkarhögskolan, tandläkarhögskolan, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2005-10-11 Created: 2005-10-11 Last updated: 2009-11-11Bibliographically approved

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