THE ROLE OF N-ACETYLCYSTEINE IN THE TREATMENT OF OTITIS MEDIA WITH EFFUSION

Dhiaa Fadhel,Isam Al-Shareda,Ahmed Alansary,Haider Al-Attar

doi:10.33762/bsurg.2019.164517

Abstract

Otitis media with effusion (OME) is a chronic accumulation of fluid within the middle ear cleft and sometimes the mastoid air cells system. The disease is more common among children. Surgical management is cost effective and carry complications from anaesthesia and surgical intervention. The condition can be resolved with high percentage by using mucopeptide breaking agent N-acetylcysteine The aim of this study is to evaluate the effect of N-acetylcysteine on the resolution of otitis media with effusion in children. Fifty seven children (107 ears) aged between 4-15 years with OME were included in this study. Patients underwent a thorough otorhinolaryngological examination and were divided into two groups; in the study group of 30 patients, N-acetylcysteine was administered, and the control group of 27 patients did not receive this treatment. Patient were followed-up at attendance, one month, two months and three months later with microscopical ear examination, tympanometric and pure tone audiometric examination. Patients were 39 males (68.4%) and 18 females(31.6%), 50 of them were with bilateral and 7 with unilateral disease. Following the treatment, there was improvement in the hearing loss as air bone gap was decreased. This improvement was statically significant in comparing the study and control groups (P value= 0.022). Number of ears with type A tympanogram increased to a rate of 74%, 71% in the right and left ears respectively in the study group. This rate was statically significant in comparing with the control group (P value=0.014). In conclusion, N-acetylcysteine is effective in the treatment of children with OME as well as that N-acetylcysteine has minimal side effect and can be used safely in patients who are medically unfit for general anaesthesia

Highlights

Otitis media with effusion (OME) is a chronic accumulation of fluid in the middle ear and sometimes in the mastoid air cells system without evidence of infection
Otitis media with effusion is quite common in children
It occurs after episodes of upper respiratory tract infection and resulting in hearing difficulty, behavioural and language developmental delay

Summary

Introduction

Otitis media with effusion (OME) is a chronic accumulation of fluid in the middle ear and sometimes in the mastoid air cells system without evidence of infection. The underlying causes for OME are; respiratory tract infections, acute otitis media and/or allergy, followed by mucous production in the middle ear. Surgery is contraindicated in patients who are medically unfit for general anaesthesia, only hearing ear, otitis externa and anatomical narrowing in the external auditory canal[3]. The most common side effects associated with high oral doses are; nausea, vomiting, and oral administration is contraindicated in persons with active peptic ulcer. Oral dose for N-acetylcysteine as a mucolytic agent is 300 mg/day in children less than 14 years and 600 mg/day in children more than 14 years in three dividing doses. The only contraindication is hypersensitivity to Nacetylcysteine[7]

Objectives

Methods

Results

Conclusion