Nakamura Yoshihisa, Hamajima Yuki, Suzuki Motohiko, Esaki Shinichi, Yokota Makoto, Oshika Masanori, Takagi Ippei, Yasui Keiko, Miyamoto Naoya, Sugiyama Kazuko, Nakayama Meiho, Murakami Shingo
Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Int J Pediatr Otorhinolaryngol. 2016 Aug;87:34-8. doi: 10.1016/j.ijporl.2016.05.027. Epub 2016 May 20.
Conventional treatment for acute otitis media mainly targets bacteria with antibiotics, neglecting to control for mediators of inflammation. Mediators of inflammation, such as leukotrienes, have been identified in patients with acute otitis media (AOM) or subsequent secretory otitis media (SOM). They can cause functional eustachian tube dysfunction or increase mucous in the middle ear, causing persistent SOM following AOM. The objective of the present study was to evaluate whether or not administration of pranlukast, a widely used leukotriene C4, D4, and E4 antagonist, together with antibiotics could inhibit the progression to SOM.
Children with AOM, who were from two to 12 years old, were randomly divided into two groups as follows: a control group in which 50 patients received antibiotic-based conventional treatment according to guidelines for treating AOM proposed by the Japan Otological Society (version 2006); and a pranlukast group, in which 52 patients were administered pranlukast for up to 28 days as well as given conventional treatment. Cases were regarded as persistent SOM when a tympanogram was type B or C2 four weeks after treatment was initiated.
Two patients in the pranlukast group and 3 patients in the control group were excluded because they relapsed AOM within 28 days after initial treatment. Therefore, the analysis included 50 and 47 subjects in the pranlukast and control groups, respectively. The percentage of patients diagnosed with persistent SOM (22.0%) was significantly smaller in the pranlukast group compared with the control group (44.7%) (p = 0.018, chi-squared test).
The results indicate that combined treatment of AOM with antibiotics and a leukotriene antagonist to control inflammation is useful for preventing progression to persistent SOM.
急性中耳炎的传统治疗主要是使用抗生素针对细菌，而忽视了对炎症介质的控制。炎症介质，如白三烯，已在急性中耳炎（AOM）或随后的分泌性中耳炎（SOM）患者中被发现。它们可导致咽鼓管功能障碍或增加中耳黏液，从而在AOM后导致持续性SOM。本研究的目的是评估广泛使用的白三烯C4、D4和E4拮抗剂普仑司特与抗生素联合使用是否能抑制病情发展为SOM。
将2至12岁的AOM患儿随机分为两组：对照组50例，根据日本耳科学会提出的AOM治疗指南（2006版）接受基于抗生素的传统治疗；普仑司特组52例，给予普仑司特治疗长达28天，并同时进行传统治疗。治疗开始四周后，鼓室图为B型或C2型的病例被视为持续性SOM。
普仑司特组有2例患者和对照组有3例患者被排除，因为他们在初始治疗后28天内AOM复发。因此，分析分别纳入了普仑司特组和对照组的50例和47例受试者。普仑司特组被诊断为持续性SOM的患者百分比（22.0%）明显低于对照组（44.7%）（p = 0.018，卡方检验）。
结果表明，AOM联合使用抗生素和白三烯拮抗剂来控制炎症，对于预防病情发展为持续性SOM是有效的。
