Новые возможности терапии экссудативного среднего отита у детей

Abstract

Anti-inflammatory therapy for otitis media with effusion (OME) in patients with chronic diseases of the Waldeyer's tonsillar ring is a key stage of treatment. Patients and methods. This observational study included 85 patients. Group 1 comprised 50 OME patients with grade I–II pharyngeal tonsil hypertrophy who were further divided into two subgroups: 1A (n = 30) and 1B (n = 20). Group 2 involved 35 OME patients on the second day after adenectomy; they were divided into subgroups 2A (n = 20) and 2B (n = 15). Children in subgroups 1A and 2A received standard OME therapy plus ammonium glycyrrhizinate (AG) for 30 days, whereas children in subgroups 1B and 2B received standard OME therapy alone. Results. Patients from the experimental subgroups (1A and 2A) who received AG demonstrated significantly lower VAS scores of both auditory symptoms (hearing loss and congestion/noise in the ear) and initial manifestations (rhinorrhea and nasal congestion) already by first follow-up visits compared to controls (subgroups 1B and 2B). Maximum differences were observed on day 30: the severity of symptoms in children from group 1A was 2.5 times lower than in children from subgroup 1B; patients from subgroup 2A also demonstrated a 2-fold reduction in symptom severity compared to children from subgroup 2B (p < 0.05). Tympanometry showed that 90% of patients in the experimental subgroups (1A and 2A) had complete restoration of auditory tube function by day 30, while in control subgroups 1B and 2B, the proportion of such patients was significantly lower (55% and 73%, respectively). Audiometry results suggest that complete hearing restoration by day 30 was more frequent in patients receiving AG than in controls (1A and 1B: 94% vs 70%; 2A and 2B: 100% vs 80%). Patients of the experimental subgroups were more satisfied with treatment results. Conclusion. The inclusion of AG into the treatment scheme for OME and auditory tube dysfunction after elective adenectomy increases treatment efficacy by normalizing drainage and ventilation functions of the middle ear, elimination of exudate, and ensuring hearing restoration. Key words: otitis media with effusion, children, auditory tube, Waldeyer's tonsillar ring, hearing loss, impedance audiometry, ammonium glycyrrhizinate