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Published on: February 27, 2018
Topical dexamethasone and tympanic membrane perforation healing in otitis media: a short-term study
Patrick J Antonelli1, Almut G Winterstein, Gregory S Schultz
1Department of Otolaryngology, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32610-0264, U.S.A. Patrick.Antonelli@ent.ufl.edu
Background:
The safety and efficacy of topical corticosteroids have not been established in the treatment of acute otitis media (AOM) with tympanic membrane (TM) perforation. Specific concerns include the risk for nonhealing TM perforations. Previous studies have not been done in models with concurrent AOM. The purpose of this study was to determine whether the addition of dexamethasone to topical ciprofloxacin affects healing of AOM-related TM perforations.
Methods:
Bilateral AOM was induced in chinchillas by transbulla injection of Streptococcus pneumoniae, and TMs were perforated with a CO2 laser 3 to 5 days later. Each animal received ciprofloxacin-dexamethasone in one ear and ciprofloxacin in the other, twice daily for 7 days. Tympanic membranes were assessed for 4 weeks.
Results:
Fifteen of 55 ciprofloxacin-treated and 37 of 55 ciprofloxacin-dexamethasone-treated TMs failed to heal within the 4-week study period (p < 0.001). Exposure to dexamethasone increased the odds for persistent perforation by 5.5 (95% confidence interval, 2.4-12.6). At 4 weeks, mean TM perforation diameter was 0.9 mm in ciprofloxacin-treated ears and 2.1 mm in ciprofloxacin-dexamethasone-treated ears (p < 0.001).
Conclusion:
Topical dexamethasone hinders TM healing in a chinchilla model of AOM at short-term follow-up. Longer follow-up is needed.
Insights
Topical dexamethasone hinders tympanic membrane healing in acute otitis media models. This corticosteroid increased the risk of nonhealing perforations compared to antibiotics alone.
Area of Science:
- Otolaryngology
- Pharmacology
- Regenerative Medicine
Background:
- Safety and efficacy of topical corticosteroids for acute otitis media (AOM) with tympanic membrane (TM) perforation remain unestablished.
- Concerns exist regarding the potential for nonhealing TM perforations with corticosteroid use.
- Prior research has not investigated this in concurrent AOM models.
Purpose of the Study:
- To evaluate if adding dexamethasone to topical ciprofloxacin impacts the healing of TM perforations associated with AOM.
Main Methods:
- Bilateral AOM was induced in chinchillas via Streptococcus pneumoniae transbulla injection.
- TMs were perforated using a CO2 laser 3-5 days post-induction.
- Animals received either ciprofloxacin-dexamethasone or ciprofloxacin alone twice daily for 7 days, with TM assessment for 4 weeks.
Main Results:
- A significantly higher rate of nonhealing TMs was observed in the ciprofloxacin-dexamethasone group (37/55) compared to the ciprofloxacin-only group (15/55).
- Dexamethasone exposure increased the odds of persistent perforation by 5.5 times.
- Mean TM perforation diameter at 4 weeks was larger in the dexamethasone-treated ears (2.1 mm) versus controls (0.9 mm).
Conclusions:
- Topical dexamethasone impedes TM healing in a chinchilla model of AOM within a short follow-up period.
- Further investigation with longer follow-up durations is warranted to fully understand the long-term effects.
