Efficacy of Boric Acid as a Treatment of Choice for Chronic Suppurative Otitis Media and Its Ototoxicity

Abstract

Chronic suppurative otitis media (CSOM) is one of the most common chronic infectious diseases worldwide, especially affecting children. The patients or the parents of the affected children are often worried about the cost of medical visits, prescription medicines, or inconsistently effective medication. The complications of CSOM have been greatly reduced because of the development of antibiotics; however, the irrational use of antibiotics has led to the emergence of organisms resistant to the commonly used drugs. Owing to the increase in antibiotic resistance, the development of new treatments that will efficiently eradicate infectious microorganisms has become imperative. Boric acid solutions are effective in the treatment of CSOM because of their acidic effect. Various databases, such as the PubMed, The Cochrane Library, and SciELO, were searched for references related to the efficacy of boric acid in the treatment of mucosal CSOM, as well as its ototoxicity. The search revealed that boric acid is relatively effective in treating CSOM, especially at a high concentration. Boric acid in distilled water was found safe in animal studies. However, the ototoxicity of boric acid concentrations higher than 4% needs further evaluation, considering the effectivity of boric acid at high concentrations.

Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-23460 | DOI: 10.14744/tjtes.2020.23460 Boric acid is as effective as hyaluronic acid-based agent in preventing intraabdominal adhesions in a rat model

“…Two review studies concluded that topical boric acid was effective in the treatment of chronic otitis media and vulvovaginal candidiasis. [31,32] Boric acid has not been investigated as a potential anti-adhesion agent ever before.…”

Antifungal efficacy of pure boron on yeast and mold isolates causing superficial mycosis

“…In some clinical studies, boric acid was also used for treating chronic suppurative otitis media. 8,9 The ototoxic potential of boric acid was investigated in some animal studies, and results revealed a tympanic membrane toxicity of 4% boric acid in 70% alcohol. 8,9,10 Microbiological studies showed that applying acid to an infected surface lowers pH and negatively affects bacterial growth.…”

“…4,5,6 However, boric acid is potentially toxic, particularly if it is ingested or systematically absorbed. [7][8][9][10][11][12][13] In addition to being non-soluble in water, elemental boron has limited industrial applications, and no study has cited its potential antifungal activity. By contrast, several studies have described the antimicrobial and antifungal properties of boric acid and boron compounds [8][9][10][11][12] .…”

Citric Acid as an Alternative to Boric Acid in the Treatment of Chronic Suppurative Otitis Media

“…We read with interest the review by Adriztina et al [1] regarding the efficacy and toxicity of boric acid in the treatment of patients with chronic suppurative otitis media (CSOM). The authors focused on the safety of boric acid at higher concentrations than those recommended for human use.…”

“…Moreover, it is reported to be effective in the treatment of patients with CSOM, especially at a high concentration [4,5]. Although the safety of a 4% boric acid solution prepared in distilled water vs. boric acid solution in 70% alcohol, is shown in animal studies [1,6], its safety for use in humans remains unknown. We are in agreement with the view of Adriztina et al that further studies are required in patients with CSOM to evaluate the treatment outcomes of boric acid and its associated ototoxicity at high concentrations [1].…”