Topical administration of hyaluronic acid in children with recurrent or chronic middle ear inflammations

Abstract

Hyaluronic acid (HA) treatment has been successfully performed in patients with recurrent upper airway infections or rhinitis. The aim of this study was to assess the efficacy and safety of the topical nasal administration of an HAbased compound by investigating its effects in children with recurrent or chronic middle ear inflammations and chronic adenoiditis. A prospective, single-blind, 1:1 randomised controlled study was performed to compare otoscopy, tympanometry and pure-tone audiometry in children which received the daily topical administration of normal 0.9% sodium chloride saline solution (control group) or 9 mg of sodium hyaluronate in 3 mL of a 0.9% sodium saline solution. The final analysis was based on 116 children (49.1% boys; mean age, 62.9 ± 17.9 months): 58 in the control group and 58 in the study group. At the end of follow-up, the prevalence of patients with impaired otoscopy was significantly lower in the study group (P value = 0.024) compared to baseline but not in the control group. In comparison with baseline, the prevalence of patients with impaired tympanometry at the end of the follow-up period was significantly lower in the study group (P value = 0.047) but not in the control group. The reduction in the prevalence of patients with conductive hearing loss (CHL) (P value = 0.008) and those with moderate CHL (P value = 0.048) was significant in the study group, but not in the control group. The mean auditory threshold had also significantly improved by the end of treatment in the study group (P value = 0.004) but not in the control group. Our findings confirm the safety of intermittent treatment with a topical nasal sodium hyaluronate solution and are the first to document its beneficial effect on clinical and audiological outcomes in children with recurrent or chronic middle ear inflammations associated with chronic adenoiditis.

Hyaluronate effect on bacterial biofilm in ENT district infections: a review

“…Administration of HA in the form of intranasal SH also produced promising results in children with otitis media with effusion and children with recurrent acute otitis media. This is documented by a recent randomized, controlled study of 116 children under the age of 12 (Table ).…”

“…The same author administered the same spray formulation (associated with saline solution) to patients undergoing FESS (15 days per month for 3 months) to compare the clinical, cytological, and endoscopic results with those of a control group treated with saline alone. Improvement in the presence of biofilms after treatment in the two groups is of borderline statistical significance (p = 0.057) . Gelardi et al studied 78 patients with allergic and non‐allergic rhinitis, to whom he administered intranasal mometasone associated, in 38 of them, with 9 mg nebulized HA twice a day.…”

Supervised Nasal Saline Irrigations in Otitis-Prone Children

“…Some studies previously documented the positive impact of medicated NSI (especially when administered by means of micronized nasal douches) in the treatment of children with chronic adenoiditis associated with recurrent or chronic middle ear infections (22, 23). In particular, Torretta et al (22, 23) reported the clinical beneficial effect of a topical nasal sodium hyaluronate solution in children with recurrent or chronic middle ear inflammations associated with chronic adenoiditis (22, 23). However, the possible effect of supervised daily nasal irrigations with 0.9% saline solution performed by means of a bulb syringe in children with RAOM has not been previously investigated.…”

Hyaluronic-Based Antibacterial Hydrogel Coating for Implantable Biomaterials in Orthopedics and Trauma: From Basic Research to Clinical Applications

“…Torretta et al [38] recently described topical administration of hyaluronic acid in children with recurrent or chronic middle ear inflammations and chronic adenoiditis.…”