Clinical Improvement of Subacute and Chronic Otitis Media With Effusion Treated With Hyaluronic Acid Plus Hypertonic Solution via Nasal Lavage: A Randomized Controlled Trial

Abstract

Background. This study, a randomized controlled trial, aims to demonstrate a clinically significant improvement in subacute and chronic otitis media with effusion through the administration of hyaluronic acid associated with hypertonic solution compared with the administration of hypertonic solution alone. The setting was an outpatient clinic of 20 primary care pediatrician offices affiliated with the 3 Local Health Units (Azienda Sanitaria Locale) of Naples. Materials and Methods. The study was conducted for 6 months, from October 2014 to the end of March 2015. The study saw the participation of 20 pediatricians who were experts in pneumatic otoscopy, each of whom enrolled 15 children. Each investigator was randomized to carry out the treatment with 3% hypertonic solution or high-molecular-weight hyaluronic acid + 3% hypertonic solution. Results. A total of 275 children were enrolled, of whom 11(equal to 4% ) were lost to follow-up. A total of 264 children completed the trial according to the protocol, 120 in the hyaluronic acid + hypertonic solution group and 144 in the hypertonic solution group. Hyaluronic acid associated with hypertonic solution and hypertonic solution alone administered by nasal lavage have proven to be safe and effective in the treatment of prolonged otitis media with effusion (initial score of −0.5, final score of 0.9, P < 001, for the hypertonic + hyaluronic acid group; initial score of −0.3, final score of 0.2, P < .001, for the hypertonic solution group). Though starting from a less favorable initial clinical score (−0.5 vs −0.3, P < .016), hyaluronic acid associated with hypertonic solution resulted in a significant increase in clinical healing (0.9 vs 0.2, P < .001). One interesting outcome was the significant reduction in the consumption of drugs (cortisone and antibiotics) during the follow-up.

Resolution of Otitis Media with Effusion in Adults after a Three-Day Course of Treatment with a Manosonic Nebulizer—A Pilot Study

“…Another randomized control trial demonstrated the clinical improvement of OME in children treated with hyaluronic acid with a hypertonic solution via nasal lavage. Moreover, a significant reduction in the consumption of steroids and antibiotics was observed during the follow-up in this study [ 18 ]. New treatment protocols for AMSA can be developed on the basis of these results.…”

“…No single perfect method for evaluating the state of the middle ear currently exists. Most studies use pure tone audiometry [ 17 , 19 ], tympanometry [ 20 , 21 ], otoscopy [ 18 ], or a combination of the above [ 11 , 22 ]. All the studies mentioned concentrate on the management of OME and evaluate the state of the middle ear before and after the intervention.…”

Hyaluronic acid concentration in the middle ear fluid as an indicator of severity of the secretory otitis in newborns with cleft palate

“…The condition can progress to chronic otitis with cholesteatoma (Abi Zeid Daou & Bassim, 2020). Current studies also show that therapeutic intranasal administration of hyaluronic acid significantly improves the course of otitis media with effusion (Cioffi et al, 2017;Topazio D et al, 2019;Torretta et al, 2016). Reference values of HA in the middle ear fluid have not yet been published.…”