Intranasal phenylephrine-surfactant treatment is not beneficial in otitis media with effusion

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

“…One of the properties of surfactant is to spread rapidly on any wet surface . Surfactant decreases the passive opening pressure of the ET by rapidly spreading over its mucosal surface, protecting the cilia, lowering the surface tension of its lining layer, and decreasing adhesion of the tube walls, thereby allowing the tube to open more readily . Intranasal PS may also easily enter the cartilaginous and osseous portions of the ET refluxed by the siphonage effect, gradient diffusion, or negative pressure in the middle ear.…”

Extrapulmonary Surfactant Therapy: Review of Available Data and Research/Development Issues

“…Another natural porcine surfactant was also tested for otitis media, and this was prepared by the Infantile Respiratory Emergency Laboratory in the Pediatric Hospital of Fudan University (China) with a total PL concentration of 40 mg/mL. 77 Various chemical compounds have been tested for obstetrical/gynecological indications, but results were not encouraging (more details in the text); thus, they are not detailed here. Surfactants investigated in very preliminary studies (such as surfactants as oral drug carriers or surfactants for ophthalmologic and dentistry indications) were not reported either.…”

“…71,72 Conversely, the addition of phenylephrine had a negative effect and was also able to abolish the effect of surfactant. 70,77 To the best of our knowledge, there is no clinical study about the use of surfactant for this indication yet. However, otitis media is extremely frequent (75% of children experience 1 or more episodes in the first 5 years of life), 78 may have worrisome complications, 79 and despite the introduction of vaccines, often requires antibiotic therapy.…”

“…Only “pulmonary‐like surfactant” (ie, surfactants that have been used for the classical respiratory indications) and chemical surfactants (ie, compounds that have already been investigated for extrapulmonary uses because of their biophysical characteristics) resulting promising, at least in preclinical studies, have been considered. Another natural porcine surfactant was also tested for otitis media, and this was prepared by the Infantile Respiratory Emergency Laboratory in the Pediatric Hospital of Fudan University (China) with a total PL concentration of 40 mg/mL 77 . Various chemical compounds have been tested for obstetrical/gynecological indications, but results were not encouraging (more details in the text); thus, they are not detailed here.…”

“…These studies used animal surfactant preparations commonly used for respiratory indications 18 and have also been studied in combination with other treatments, such as local steroids, without significant differences 71,72 . Conversely, the addition of phenylephrine had a negative effect and was also able to abolish the effect of surfactant 70,77 …”