Ear infections-Medscape article

[Guest guest]

Hi, Everyone....I know that when Gareth was younger, water behind the ear

was a major problem. I found this interesting.

From _Medscape Medical News_ (http://www.medscape.com/news)

Antihistamine-Antibiotic Combo Speeds Resolution of Otitis Media

Fran Lowry

INovember 23, 2010 (Phoenix, Arizona) — Adding the nasal antihistamine

olopatadine to oral antibiotic therapy hastens the resolution of serous otitis

media in children, according to a study presented here at the American

College of Asthma, Allergy & Immunology (ACAAI) 2010 Annual Scientific

Meeting.

" Otitis media with effusion is a very important problem, " Safa M. Nsouli,

MD, director of the Danville Asthma and Allergy Clinic and the Castro Valley

Asthma and Allergy Clinic in Danville, California, told Medscape Medical

News. " It is very frequent, and the reason for the most visits to the

paediatrician. We want to treat these children quickly so that any damage to

the

middle ear is lessened. "

Chronic inflammation is the histopathologic landmark of otitis media with

effusion, and past observations have led Dr. Nsouli to believe that adding

an antihistamine to antibiotic therapy would be more effective in this

setting.

" The advantage of olopatidine is that it is a very gentle antihistamine and

does not contain steroids, " he noted. " It is so safe it was used as eye

drops, and the fact that it does not contain steroids is reassuring to

parents. "

In his study, which was randomized and open labeled, Dr. Nsouli compared

the efficacy of nasal olopatadine (665 μg per nostril twice daily) together

with oral amoxicillin/clavulanate potassium (90 mg/kg daily given in 2

divided doses every 12 hours) with that of the antibiotic alone in 40 pediatric

patients (20 patients in each group) aged 6 to 11 years. The duration of

the study was 2 weeks.

Efficacy was assessed with pneumatic otoscopy, impedance tympanometry, and

audiometry on day 7 and day 14 of the study.

Using impedance tympanometry was the key to assessing the effect of adding

the antihistamine, Dr. Nsouli said. " These are little children, and

sometimes they cannot describe in words very accurately what they are feeling.

Tympanometry is an objective way to measure improvement. "

At day 7, the children who were receiving both medications showed a

complete resolution of their otitis media with effusion. In contrast, the group

treated with antibiotics alone showed no improvement until day 14, Dr. Nsouli

said.

" It is very important to think of the middle ear as a sinus cavity, and to

treat it as such, " he said. " That is why it is logical to combine

treatments. Rather than thinking of the ear as one target, and the sinus as

another,

we should be giving a treatment that targets both at once. "

Comments: Combination a Novel Idea

nne Frieri, MD, PhD, chief of allergy and immunology at Nassau

University Medical Center, East Meadow, New York, commented that adding a nasal

antihistamine along with an antibiotic seems like a good idea.

" We know that olopatadine has many effects on various inflammatory cells,

so adding it to an antibiotic sounds like a smart thing to do, " Dr. Frieri,

who comoderated the session, told Medscape Medical News.

" I thought this study was very interesting. It is quite novel to add a

nasal antihistamine because of histamine in the ear fluid, to an antibiotic. It

makes the time to treat shorter. It was a wise thing to do, " she said.

Dr. Frieri's comoderator, ph A. Bellanti, MD, professor of pediatrics

and microbiology and immunology at town University Medical Center,

Washington, DC, agreed. " The study suggests that the serous otitis media may

be due to an infection, so adding the antibiotic to the histamine makes

sense. You get a double effect. "

For his part, Dr. Nsouli added: " We don't want to use too many antibiotics,

and we don't want children to suffer the ill effects of not being able to

hear because this can cause learning difficulties, which can be

irreversible. Also, the ear infection can cause lasting damage. This is a safe

treatment that gets the children better faster. "

Drs. Nsouli, Frieri, and Bellanti have disclosed no relevant financial

relationships.

American College of Asthma, Allergy & Immunology (ACAAI) 2010 Annual

Scientific Meeting: Abstract 22: Presented November 14, 2010.