Role of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment of chronic suppurative otitis media.
BACKGROUND
It is conventional to use antibiotic-steroid combination eardrops, although the advantage of steroid combination has not been substantiated. The present prospective randomized comparative study is designed to assess the role of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment of chronic suppurative otitis media (CSOM).


METHODS
Pre-treatment clinical assessment, bacteriology of the middle ear discharge and pure tone audiogram were done. CSOM with organisms sensitive to gentamicin were treated either with plain gentamycin (GM) or gentamycin steroid combination (GM-S) eardrops for a period of 3 weeks. Post-treatment clinical, bacteriological and audiogram response was recorded 1 week after discontinuing the eardrops. The post-treatment clinical improvement, bacteriologic improvement and changes in hearing threshold at speech frequencies were analyzed by using unpaired Student's t test and chi(2) tests.


RESULTS
The most common organism associated with CSOM was Pseudomonas aeruginosa (33.92%). Clinical improvement was seen in 87.7 and 86.5% cases but bacteriological improvement in only 82.5 and 75% of cases treated with GM and GM-S (p >0.05), respectively. On comparing the pre- and post-treatment pure tone audiograms in 95 patients, 28.9% treated with GM and 30% with GM-S showed deterioration in bone conduction threshold above 5 dB (p >0.05) at speech frequencies. The mean increase in bone conduction in the two groups was 7.7 and 8.57 dB (p >0.05), respectively.


CONCLUSIONS
Our results indicate that there is no difference in the clinical and bacteriological improvement or ototoxicity either with topical GM or GM-S. Hence, we conclude that it is unnecessary to combine steroids with topical antibiotic preparations for the management of CSOM.
Indudharan
Ramunnikutty
R
Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Malaysia.
Valuyeetham
Kamaru Ambu
KA
Raju
Suraparaju Sivachandra
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D001419:Bacteria / Q000302:isolation & purification; D001623:Betamethasone / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010035:Otitis Media, Suppurative / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D005938:Glucocorticoids; D001623:Betamethasone