Intranasal Surfactant Aerosol Therapy for Otitis Media With Effusion

Abstract

Objective: To determine the effect of surfactant alone and with other medications delivered intranasally as a metered dose inhaler (MDI) aerosol on the resolution of experimentally induced otitis media with effusion (OME). Background: Eustachian tube dysfunction is a primary factor in the pathogenesis of OME. Intranasal surfactant via MDI has been shown in this laboratory to reduce passive opening pressure of the eustachian tube in normal gerbils and mice. Study Design: OME was developed in 35 gerbils by transtympanic injection of 10 g lipopolysaccharide from Klebsiella pneumoniae. Pretreatment otomicroscopy and tympanometry were performed to exclude pre-existing middle ear disease, and postinfection evaluations were performed on alternate days for a period of 30 days. Five animals received no treatment (control group); four were treated with propellant only (placebo); seven received surfactant alone; eight received surfactant and betamethasone; and six received surfactant with phenylephrine. All medications were sprayed intranasally as an aerosolized MDI and administered daily from postinfection day 2 onward. Results: OME resolved after 16.0 ؎ 0.44 days (mean ؎ SD) in controls. There was no difference seen in the placebo or the surfactant with phenylephrine groups. Treatment with surfactant yielded resolution in 10.57 ؎ 0.37 days; this was reduced to 8.57 ؎ 0.37 days with surfactant plus betamethasone. These differences are statistically significant. There was no recurrence of OME in any group. Conclusion: This study demonstrates that using an aerosolized MDI surfactant with and without betamethasone decreases the duration of OME in this in vivo gerbil model. Key Words: Surfactant, otitis media with effusion, gerbil, aerosolized metered dose inhaler, eustachian tube dysfunction.

Efficacy of transnasal nebulized surfactant on experimental otitis media with effusion in guinea pig

“…Native SP-B, isolated from human bronchioalveolar lavage fluid, killed clinical isolates of gram-positive and gram-negative bacteria in a dose-dependent manner [20]. The current experiments demonstrated that aerosolized metered dose inhalant delivery of synthetic surfactant was effective in reducing passive opening pressure in the animal with OME or acute otitis media [2][3][4]. This surfactant is a synthetic phospholipids without protein.…”

Effect of Nebulized Bovine Surfactant for Experimental Otitis Media with Effusion

“…SP-B was recently shown to share features with antimicrobial peptides, and native SP-B isolated from human bronchioalveolar lavage fluid was demonstrated to kill clinical isolates of gram-positive and gram-negative bacteria in a dose-dependent manner (26). Inhalation delivery of an aerosolized metered dose of synthetic surfactant comprised of phospholipid and protein is effective in reducing the POPs in animals with OME or acute otitis media (10-12). The primary function of the synthetic surfactant is obviation of adhesion (12).…”

“…Exogenous natural (7-9) and synthetic (10-12) surfactant preparations can reduce the passive opening pressure (POP), which is the pressure required to force the Eustachian tube open. Over 90% of the known surfactants are phospholipids whose chemical structure possesses both a hydrophilic and hydrophobic character in different regions of the compounds.…”

“…Surfactant associated protein (SP), and especially SP-A and SP-D, has immune modulating properties (13-15). Intranasally-metered dose inhalation of aerosolized synthetic surfactant is effective in reducing the Eustachian tube POP (10-12), but the synthetic surfactants lack SPs. Although clinical trials have demonstrated that both synthetic surfactants and natural pulmonary surfactant preparations are effective to relieve lung disease, comparisons in animal models has suggested that the natural surfactant products may provide greater efficacy, and perhaps this is due to their protein content (16).…”

Pathological study of otitis media with effusion after treatment with intranasal pulmonary surfactant

“…Flisberg et al suggested that the presence of surface, tension‐lowering substances (surfactants) might influence the function of the ET. Several recent studies have investigated the efficacy of surfactant therapy on the resolution of OME . These studies were conducted by inducing acute OME experimentally with a bacterial agent, administering surfactant on a periodic basis, and observing the resolution time.…”