Rational approach to the treatment of otitis externa
DOI: 10.32364/2587-6821-2022-6-7-404-410
A.V. Gurov1,2, A.V. Muzhichkova1,2
1L.I. Sverzhevskiy Research Clinical Institute of Otorhinolaryngology, Moscow, Russian Federation
2Pirogov Russian National Research Medical University, Moscow, Russian Federation
In recent years, there has been an increased number of calls to ENT specialists concerning otitis externa. These conditions are characterized by antibiotic resistance of key pathogens, as well as the presence of significant pain symptoms. In 60–98% of cases, inflammation in the external auditory canal has a bacterial etiology. Pseudomonas aeruginosa occupies a leading place in the microbial landscape — up to 78% on average, while Staphylococcus aureus is sown only in 9–27% of cases. Rational therapy of otitis externa is one of the urgent problems of otorhinolaryngology, despite the large variety of treatment methods. It is necessary to use complex therapy of external otitis, including a direct effect on the etiological factor, as well as pain relief. In the vast majority of cases, the frontline empirical therapy of otitis externa should be topical antimicrobial agents. The following combined drug is successfully used for the treatment of otit is externa: ear drops containing a combined antibiotic (aminoglycoside neomycin + cyclic polypeptide polymyxin B + topical anesthetic lidocaine). Early therapy of otitis externa with a combined antibiotic is the key to a fast and reliable clinical result.
Keywords: otitis externa, bacterial otitis, ear drops, combined antibiotic, aminoglycoside, cyclic polypeptide, topical anesthetics, neomycin, polymyxin B, lidocaine.
For citation: Gurov A.V., Muzhichkova A.V. Rational approach to the treatment of otitis externa. Russian Medical Inquiry. 2022;6(7):404–410 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-404-410.
About the authors:
Alexander V. Gurov — Dr. Sc. (Med.), Professor of the Department of Otorhinolaryngology of B.S. Preobrazhensky Medical Faculty and the Department of Microbiology and Virology of the Pediatric Faculty, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; Senior Researcher of the L.I. Sverzhevskiy Research Clinical Institute of Otorhinolaryngology; 18A, build. 2, Zagorodnoe road, Moscow, 117152, Russian Federation; ORCID iD 0000-0001-9811-8397.
Anna V. Muzhichkova — C. Sc. (Med.), Assistant Professor of the Department of Otorhinolaryngology of B.S. Preobrazhensky Medical Faculty, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; Associate Professor of the academic office of L.I. Sverzhevskiy Research Clinical Institute of Otorhinolaryngology; 18A, build. 2, Zagorodnoe road, Moscow, 117152, Russian Federation; ORCID iD 0000-0001-5940-9343.
Contact information: Alexander V. Gurov, e-mail: alex9999@ inbox.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 05.07.2022.
Revised 28.07.2022.
Accepted 22.08.2022.
2. Juhn S.K., Jung M.K., Hoffman M.D. et al. The role of inflammatory mediators in the pathogenesis of otitis media and sequelae. Clin Exp Otorhinolaryngol. 2008;1(3):117–138. DOI: 10.3342/ceo.2008.1.3.117.
3. Pluzhnikov M.S., Lavrenova G.V., Diskalenko V.V. Diseases of the outer ear. SPb.: Meditsinskoye izdatel’stvo; 2000 (in Russ.).
4. Kosyakov S.Ya., Kurlova A.V. Inflammatory diseases of the external auditory canal and methods of their treatment. Vestnik otorinolaringologii. 2011;1:81–84 (in Russ.).
5. Martin T.J., Kerschner J.E., Flanary V.A. Fungal causes of otitis externa and tympanostomy tube otorrhea. Int J Pediatr Otorhinolaryngol. 2005;69(11):1503–1508. DOI: 10.1016/j.ijporl.2005.04.012.
6. Sood S., Strachan D.R., Tsikoudas A., Stables G.I. Allergic otitis externa. Clin Otolaryngol Allied Sci. 2002;27(4):233–236. DOI: 10.1046/j.1365-2273.2002.00584.x.
7. Coker T.R., Chan L.S., Newberry S.J. et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161–2169. DOI: 10.1001/jama.2010.1651.
8. Gajdács M., Baráth Z., Kárpáti K. et al. No Correlation between Biofilm Formation, Virulence Factors, and Antibiotic Resistance in Pseudomonas aeruginosa: Results from a Laboratory-Based In Vitro Study. Antibiotics (Basel). 2021;10(9):1134. DOI: 10.3390/antibiotics10091134.
9. Whistler T., Sangwichian O., Jorakate P. et al. Identification of Gram negative non-fermentative bacteria: How hard can it be? PLoS Negl Trop Dis. 2019;13(9):e0007729. DOI: 10.1371/journal.pntd.0007729.
10. Fiscarelli E.V., Rossitto M., Rosati P. et al. In Vitro Newly Isolated Environmental Phage Activity against Biofilms Preformed by Pseudomonas aeruginosa from Patients with Cystic Fibrosis. Microorganisms. 2021;9(3):478. DOI: 10.3390/microorganisms9030478.
11. Klockgether J., Tümmler B. Recent advances in understanding Pseudomonas aeruginosa as a pathogen. F1000Res. 2017;6:1261. DOI: 10.12688/f1000research.10506.1.
12. Çiçek A., Ertürk A., Ejder N. et al Screening of antimicrobial resistance genes and epidemiological features in hospital and community-associated carbapenem-resistant pseudomonas aeruginosa infections. Infect. Drug Resist. 2021;14:1517–1526. DOI: 10.2147/IDR.S299742.
13. Migiyama Y., Yanagihara K., Kaku N. et al. Pseudomonas aeruginosa bacteremia among immunocompetent and immunocompromised patients: Relation to initial antibiotic therapy and survival. Jpn J Infect Dis. 2016;69(2):91–96. DOI: 10.7883/yoken.JJID.2014.573.
14. Yang K., Xiao T., Shi Q. et al. Socioeconomic burden of bloodstream infections caused by carbapenem-resistant and carbapenem-susceptible Pseudomonas aeruginosa in China. J Glob Antimicrob Resist. 2021;26:101–107. DOI: 10.1016/j.jgar.2021.03.032.
15. Hilliam Y., Kaye S., Winstanley C. Pseudomonas aeruginosa and microbial keratitis. J Med Microbiol. 2020;69(1):3–13. DOI: 10.1099/jmm.0.001110.
16. Behzadi P., Baráth Z., Gajdács M. It’s Not Easy Being Green: A Narrative Review on the Microbiology, Virulence and Therapeutic Prospects of Multidrug-Resistant Pseudomonas aeruginosa. Antibiotics (Basel). 2021;10(1):42. DOI: 10.3390/antibiotics10010042.
17. Morin C.D., Déziel E., Gauthier J. et al. An Organ System-Based Synopsis of Pseudomonas aeruginosa Virulence. Virulence. 2021;12(1):1469–1507. DOI: 10.1080/21505594.2021.1926408.
18. Moradali M.F., Rehm B.H.A. Bacterial biopolymers: from pathogenesis to advanced materials. Nat Rev Microbiol. 2020;18(4):195–210. DOI: 10.1038/s41579-019-0313-3.
19. Thi M.T.T., Wibowo D., Rehm B.H.A. Pseudomonas aeruginosa Biofilms. Int J Mol Sci. 2020;21(22):8671. DOI: 10.3390/ijms21228671.
20. Tam K., Torres V.J. Staphylococcus aureus Secreted Toxins and Extracellular Enzymes. Microbiol Spectr. 2019;7(2):10.1128/microbiolspec.GPP3–0039–2018. DOI: 10.1128/microbiolspec.GPP3-0039-2018.
21. Kusch H., Engelmann S. Secrets of the secretome in Staphylococcus aureus. Int J Med Microbiol. 2014;304(2):133–141. DOI: 10.1016/j.ijmm.2013.11.005.
22. Alonzo F. 3rd, Torres V.J. The bicomponent pore-forming leucocidins of Staphylococcus aureus. Microbiol Mol Biol Rev. 2014;78(2):199–230. DOI: 10.1128/MMBR.00055-13.
23. Gurov A.V., Yushkina M.A. Features of the clinical course and etiotropic therapy of otitis externa. RMJ. 2016;21:4126–413 (in Russ.).
24. Kunel’skaya V.Ya., Shadrin G.B. A modern approach to the diagnosis and treatment of mycotic lesions of the ENT organs. Vestnik otorinolaringologii. 2012;6:76–81 (in Russ.).
25. Fedorova O.V., Shadrin G.B. A modern view on the treatment of diffuse otitis externa. Vestnik otorinolaringologii. 2016;81(3):51–53 (in Russ.).
26. National Institute on Deafness and other Communicative Disorders. Ear Infections in Children. (Electronic resource.) URL: http://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx (access date: 02.07.2022).
27. Turovskii A.B., Popova I.A., Shadrin G.B. Modern approaches to the treatment of otitis externa of various etiologies. RMJ. 2017;6:420–423 (in Russ.).
28. Otorhinolaryngology: national guidelines. Ed. V.T. Palchun. M.: GEOTAR-Media; 2008 (in Russ.).
29. External otitis. Clinical guidelines of the national medical association of otorhinolaryngologists. 2021 (in Russ.).
30. Ramakrishnan K., Sparks R.A., Berryhill W.E. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76(11):1650–1658. PMID: 18092706.
31. Gurov A.V., Yushkina M.A. Features of the clinical course and etiotropic therapy of otitis externa. RMJ. 2016;21:4126–4131 (in Russ.).
32. Tempera G., Mangiafico A., Genovese C. et al. In vitro evaluation of the synergistic activity of neomycin-polymyxin B association against pathogens responsible for otitis externa. Int J Immunopathol Pharmacol. 2009;22(2):299–302. DOI: 10.1177/039463200902200206.
33. Okovityj S.V., Ivkin D.Ju., Malygin S.V. Medicamental therapy of otitis externa and otitis media. Vestnik Otorinolaringologii. 2012;77(1):52–56 (in Russ.).
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