Abstract

BackgroundChronic suppurative otitis media can be recalcitrant and difficult to treat, particularly with the increasing occurrence of antibiotic resistance. Lactobacillus plantarum is a probiotic that has been shown to decrease S. aureus and P. aeruginosa growth in wounds, making it a good candidate for the treatment of chronic suppurative otitis media. However, before it can be applied in the ear, its ototoxicity potential must be evaluated.MethodsA prospective controlled trial was conducted in a chinchilla animal model at the Animal care research facilities of the Montreal Children’s Hospital Research Institute to determine whether Lactobacillus plantarum is ototoxic when applied transtympanically. Ten chinchillas each had one ear randomly assigned to receive 109 CFU/mL of Lactobacillus plantarum solution, while the contralateral ear received saline. Auditory brainstem responses were measured bilaterally at 8, 20, 25 kHz before, at 7–10 days after application, and at 28 days after application of probiotic or saline. Facial nerve and vestibular function were assessed clinically.ResultsThere were no statistically significant differences in hearing thresholds between control and experimental ears at 28 days after application. A difference of 11 dB was noted in the 25 kHz range at day 7–10, but resolved by day 28. No animals receiving probiotics developed vestibular nerve dysfunction. There was no histologic evidence of auditory hair cell damaged evidenced by scanning electron microscopy.ConclusionOur study suggests that a single application of Lactobacillus plantarum at 109 CFU/mL does not cause ototoxicity in a chinchilla animal model. These preliminary safety evaluations and the pathogen inhibitory effects of L. plantarum demonstrated by previous studies present this probiotic as a candidate of interest for further investigation.

Highlights

  • Chronic suppurative otitis media can be recalcitrant and difficult to treat, with the increasing occurrence of antibiotic resistance

  • Probiotic preparation and dose selection Previous studies testing the activity of Lactobacillus plantarum against Staphyloccus aureus or Pseudomas aeruginosa on wounds used concentrations of 105 to 1.5 × 108 CFU/ml [19,20,21]

  • This study demonstrates that a 1.5 × 109 CFU/mL solution of L. plantarum applied a single time intratympanically is not ototoxic in a chinchilla animal model

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Summary

Introduction

Chronic suppurative otitis media can be recalcitrant and difficult to treat, with the increasing occurrence of antibiotic resistance. Chronic suppurative otitis media (CSOM) can be challenging to treat, when complicated by antibiotic resistance or secondary otomycosis. It is the leading cause of childhood hearing impairment in the developing countries [1] and has had serious implications for speech and language development in children [1,2,3], impacting cognitive and education outcomes [4]. The first-line treatment for uncomplicated CSOM involves antibiotics and anti-inflammatory agents applied topically to the ear. This treatment best achieves the highest dose delivery with the least secondary effects [7]. Prolonged use of antibiotics has been associated with development of otomycosis [8]

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