The effect of topical ciprofloxacin and steroid-containing ear drops for chronic suppurative otitis media on the internal ear

 European Archives of Oto-Rhino-Laryngology
Volume 267, Number 1 / January, 2010
Zeliha Kapusuz1, Erol Keles1, Hayrettin Cengiz Alpay1 , Turgut Karlidag1, Irfan Kaygusuz1, Ali Kemal Uzunlar2, Israfil Orhan1 and Sinasi Yalcin1(1) Department of Otorhinolaryngology, Firat University Medical Faculty, 23200 Elazig, Turkey
(2) Department of Pathology, Duzce University Medical Faculty, Duzce, Turkey


Received: 19 March 2009 Accepted: 4 June 2009 Published online: 25 June 2009
Abstract Aim of the study is to evaluate the effects of topical ciprofloxacin and prednisolone-containing ear drops for chronic suppurative otitis media on hearing threshold, cochlear reserve and cochlea morphology in healthy subjects and to determine the proper drug dose. Sixty-eight guinea pigs, all of which had healthy hearing, were used for the study. The first group (n = 30) was administered ciprofloxacin three times a day, the second group (n = 30) was administered prednisolone three times a day and the third group (n = 8) was administered sterile distilled water three times a day. The therapies lasted for 7 days and were administered intratympanically. The first group and second group were divided into three sub-groups of ten subjects. The first sub-group (n = 10) was administered an equivalent dose per kilogram as in humans, the second sub-group (n = 10) was administered one-third of the human-equivalent dose and the third sub-group (n = 10) was administered tenfold the human-equivalent dose. All subjects underwent brainstem evoked response audiometry (BERA) and distortion product otoacoustic emission (DPOAE) testing on the seventh and twenty-first days following the therapy. Following the tests, two subjects from each group were decapitated and examined under electron microscope. BERA and DPOAE testing results of the sub-group (n = 10) which was administered tenfold the human-equivalent dose were significantly different from the control group and other groups (P < 0.05). According to electron microscopic examination of the cochlea, the group which was administered a tenfold human-equivalent dose of intratympanic ciprofloxacin and prednisolone showed atrophy in cells and degenerations in cilia. This case was statistically significant when compared with the control group and other groups (P < 0.05).
Ciprofloxacin and prednisolone applied at a human-equivalent dose per kilogram did not affect the hearing and cochlear histology of subjects.

Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes

Otolaryngology - Head and Neck Surgery 141 (5), 572-8 (Nov 2009)  Han CS, Park JR, Boo SH, Jo JM, Park KW, Lee WY, Ahn JG, Kang MK, Park BG, Lee H 

OBJECTIVE: The purpose of this study is to compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic steroids as an initial treatment of sudden sensorineural hearing loss (SNHL) with diabetes. STUDY DESIGN: Prospective, nonrandomized multicenter clinical trial. SETTING: Multicenter study in Busan and Masan, South Korea. SUBJECTS AND METHODS: A total of 114 sudden SNHL patients who were diagnosed with diabetes were divided into peroral (PO) group (n = 48), intravenous (IV) group (n = 32), and intratympanic (IT) group (n = 34). In the PO group, prednisolone was used orally for 10 days, per schedule. In the IV group, prednisolone was administered intravenously for seven days, followed by oral administration of tapered doses for another several days. In the IT group, dexamethasone was injected into the tympanic cavity four times within a two-week period. Hearing outcome was assessed before and after the treatment. RESULTS: All groups showed significant improvement with criteria of 15 dB (P<0.05). However, there was no significant difference in hearing gain and recovery rate among groups (P>0.05). Systemic steroid treatment was stopped for two patients in the IV group and for one in the PO group due to uncontrolled hyperglycemia. However, in the IT group, there were no patients who failed to control their blood sugar level. 

CONCLUSION: ITSI is as effective as systemic steroid treatment for sudden SNHL patients with diabetes and it can avoid undesirable side effects. Therefore, we consider ITSI to be a more reasonable alternative as an initial treatment for sudden SNHL patients with diabetes.