Stenting the Eustachian tube to treat chronic otitis media - a feasibility study in sheep

Pohl, Friederike; Schuon, Robert; Miller, Felicitas; Kampmann, Andreas; Bültmann, Eva; Hartmann, Christian; Lenarz, Thomas; Paasche, Gerrit

doi:10.1186/s13005-018-0165-5

Cited by 19 publications

(22 citation statements)

References 32 publications

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“…As observed in a previous study [25], chronic otitis media leads to destruction of the middle ear and the treatments currently available provide limited relief, which was not observed in the treatment prescribed in this case, absence of pain being observed within a few days. The results observed provided a more rapid recovery in relation to treatment with local, systemic antibiotics, with resolution of otitis in 7 laser phototherapy sessions.…”

Section: Discussionsupporting

confidence: 63%

Laser Photobiomodulation and Antimicrobial Photodynamic Therapy in the Treatment of Ovine Otitis

Silva

Ferreira

Michel

et al. 2021

Acta Scientiae. Vet.

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Background: Otitis is a severe inflammation of the skin of the auditory canal which can impact animals of all ages. In sheep, this disease can occur in isolated cases or in the entire flock. Laser photobiomodulation can be used in combination with medication or as single therapy and the effects are analgesia, modulation of the inflammatory process, edema reduction, tissue restoration and stimulation of local microcirculation. Antimicrobial photodynamic therapy stands out as a promising alternative to antimicrobial drugs for the treatment of localized infections. This study aimed to report the use of laser phototherapies on a sheep with bacterial otitis.Case: A case of bacterial otitis in a 4-year-old sheep, Dorper, was treated at the Veterinary Hospital of the State University of Santa Cruz. In the anamnesis, the owner reported that the patient presented crusts in the auricular pavilions, and had been medicated with oxytetracycline 20%, administered intramuscularly, for two days and the crusts cleaned with iodine 10%, but the animal did not present clinical improvement. On physical examination, the animal presented constant head swaying, edema of the ears, otalgia, enlarged parotid lymph nodes and ear wounds. No ear discharge was observed, and the initial diagnosis was aural hematoma. The treatment prescribed was laser photobiomodulation for three consecutive days. The lesions were irradiated with a diode laser with a power of 0.1 W, irradiance of 3.5 W/cm2, continuous emission, spot area of 0.028 cm2, wavelength of 808 nm, energy of 4J/point, and fluency/point of 142.8J/cm2, with seven points on the external surface and four points on the internal surface of both ears. Two points were also targeted on the parotid lymph nodes with infrared laser (λ = 808 nm), with energy of 2J/point. On the fourth day of hospitalization, there was a reduction in lesions, decreased edema and absence of pain and on the sixth day of hospitalization, the patient presented mucopurulent otorrhea. The material from the auricular pavilions was collected for cytological examination, confirming the clinical diagnosis of bacterial otitis. Two sessions of Antimicrobial Photodynamic Therapy (aPDT) were performed with an interval of 48 hours, with application of 0.01 % methylene blue, pre-irradiation time of five minutes and irradiation with diode laser with a power of 0.1 W, 660 nm wavelength and 9J/point energy. On the 10 th day after the start of the treatment, there was no pain, healing of ear wounds, and no otorrhea. An additional photobiomodulation session was performed on the unhealed wounds in the auditory canal with red laser (λ = 660nm), on 5 points with an energy of 1J/point. On the 15th day, the left ear was healed and the right ear presented otorrhea, and a further session of aPDT was performed. On the 17th day after starting treatment there was no secretion and all lesions were healed. The patient was subsequently monitored for one month, showing no change or relapse.Discussion: Laser photobiomodulation treatment and antimicrobial photodynamic therapy were efficient in treating bacterial otitis without the use of antibiotics, promoting clinical improvement and patient well-being, making it an alternative to conventional treatment. After searches on the Pubmed, Scielo and Escopus databases using photobiomodulation and antimicrobial photodynamic therapy in sheep otitis as descriptors, this is believed to be the first report on the use of laser phototherapy in sheep otitis. Further studies are needed to establish the dosimetry and frequency of the sessions, as, besides considering animal well-being, this species is an excellent model for human experimentation.

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Section: Discussionsupporting

confidence: 63%

Laser Photobiomodulation and Antimicrobial Photodynamic Therapy in the Treatment of Ovine Otitis

Silva

Ferreira

Michel

et al. 2021

Acta Scientiae. Vet.

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“…The cross-sectional images of the optical coherence tomography were compared with histological cross-sections, generated in a previous study 20 with the following protocol. The specimens were washed in physiological saline solution and fixed in formalin (3.5 per cent, pH 7.4) for two weeks.…”

Section: Methodsmentioning

confidence: 99%

Intraluminal three-dimensional optical coherence tomography – a tool for imaging of the Eustachian tube?

et al. 2019

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ObjectivesThe cause of Eustachian tube dysfunction often remains unclear. Therefore, this study aimed to examine the feasibility and possible diagnostic use of optical coherence tomography in the Eustachian tube ex vivo.MethodsTwo female blackface sheep cadaver heads were examined bilaterally. Three conditions of the Eustachian tube were investigated: closed (resting position), actively opened and stented. The findings were compared (and correlated) with segmented histological cross-sections.ResultsIntraluminal placement of the Eustachian tube with the optical coherence tomography catheter was performed without difficulty. Regarding the limited infiltration depth of optical coherence tomography, tissues can be differentiated. The localisation of the stent was accurate as was the lumen.ConclusionThe application of optical coherence tomography in the Eustachian tube under these experimental conditions is considered to be a feasible, rapid and non-invasive diagnostic method, with possible diagnostic value for determining the luminal shape and superficial lining tissue of the Eustachian tube.

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“…Additionally, there are new treatment options-such as stents for the ET-under development striving to facilitate ventilation of the middle ear and enable clearance of secretion. These stents shall be inserted into the ET via nose and pharyngeal orifice of the ET and underwent first successful tests in cadavers [14] and sheep [15]. In order to ensure safe application, stent sizes have to be appropriate for the individual patient and tools for atraumatic positioning have to be developed.…”

Section: Introductionmentioning

confidence: 99%

Dimensions and position of the Eustachian tube in Humans

et al. 2020

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Eustachian tube (ET) dysfunction is one of the causes for chronic otitis media. To develop new therapies such as stents to facilitate middle ear ventilation, a better knowledge on dimensions and positions of the ET in individual patients is necessary. Cone beam CT scans of 143 patients were retrospectively investigated. Parameters such as lengths of the ET and its cartilaginous and bony parts, diameters, angles as well as distance of the ostium from the nasal conchae were determined and evaluated for side, gender and age specific differences. The average length of the cartilaginous and bony tubes was smaller in women than men. The average deviation from the horizontal plane was 1.7˚larger on the left side (35.4˚) compared to the right side (33.7˚). Tools to manipulate the ET or to insert stents into the ET should cover angles from at least 42˚to 64˚. The distance of the pharyngeal orifices from the conchae nasalis inferior increased with age, becoming most prominent above 70 years of age. This investigation provides necessary information to develop stents for human application and tools for safe positioning of the stents.

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Stenting the Eustachian tube to treat chronic otitis media - a feasibility study in sheep

Cited by 19 publications

References 32 publications

Laser Photobiomodulation and Antimicrobial Photodynamic Therapy in the Treatment of Ovine Otitis

Laser Photobiomodulation and Antimicrobial Photodynamic Therapy in the Treatment of Ovine Otitis

Intraluminal three-dimensional optical coherence tomography – a tool for imaging of the Eustachian tube?

Dimensions and position of the Eustachian tube in Humans

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