New Concepts for Steroid Use in Otitis Media with Effusion

Role of topical intranasal steroids in pediatric hearing loss due to otitis media with effusion: the experiences

“…17 It is thought that intranasal steroids spray may clear the effusion from the middle ear by stabilizing membrane phospholipids breakdown so that preventing formation of arachidonic acid and related inflammatory mediators. 18 It also shrinks peritubal lymphoid tissue, increase secretion of eustachian tube surfactant and decrease middle ear fluid viscosity. 18 As OME fluctuates, initial management is audiometric confirmation and quantification of the hearing loss, counseling to the parents or care givers and watchful waiting with audiometric monitoring.…”

“…18 It also shrinks peritubal lymphoid tissue, increase secretion of eustachian tube surfactant and decrease middle ear fluid viscosity. 18 As OME fluctuates, initial management is audiometric confirmation and quantification of the hearing loss, counseling to the parents or care givers and watchful waiting with audiometric monitoring. There is statistically significant improvement of the relieve of OME with intra-nasal mometasone spray in comparison to control group.…”

Activation of epithelial sodium channel in human middle ear epithelial cells by dexamethasone

“…Mechanisms proposed for the action of corticosteroids in otitis media with effusion include: (1) a direct anti-inflammatory action on the middle ear and Eustachian tube by reducing arachidonic acid concentration, thereby inhibiting the cyclo-oxygenase and lipooxygenase pathways for synthesis of inflammatory mediators; (2) an increase in Eustachian tube surfactant concentration, facilitating better tube function; (3) shrinkage of peritubal lymphoid tissue, again allowing better tube function; and (4) reduction of middle ear fluid viscosity via an effect on mucoproteins. (Rosenfeld, 1992;Butler and Van Der Voort, 2001). Down-regulation of inflammatory cytokine production by glucocorticoids is well-known and may be another mechanism for enhanced resolution of effusion in otitis media with effusion.…”

Steroids for Otitis Media With Effusion

“…ARTICLE From the Departments of Family Medicine (Dr Butler) and Pediatrics (Dr van der Voort), McMaster University Medical Centre, Hamilton, Ontario. membrane phospholipid breakdown and, thus, preventing the formation of arachidonic acid and associated inflammatory mediators; (b) shrinking peritubal lymphoid tissue; (c) enhancing secretion of eustachian tube surfactant; and (d) reducing middle ear fluid viscosity. 12 Topical intranasal steroids may be safer than systemic preparations because the glucocorticoid is rapidly degraded in the nasal mucosa to less active metabolites and any unchanged drug that is absorbed is metabolized in the first pass through the liver. 13 Systemic adverse effects are, therefore, less likely, while the desired antiinflammatory effects may be similar.…”