Topical Dexamethasone and Tympanic Membrane Perforation Healing in Otitis Media

Abstract

The safety and efficacy of topical corticosteroids have not been established in the treatment of acute otitis media (AOM) with tympanic membrane (TM) perforation. Specific concerns include the risk for nonhealing TM perforations. Previous studies have not been done in models with concurrent AOM. The purpose of this study was to determine whether the addition of dexamethasone to topical ciprofloxacin affects healing of AOM-related TM perforations. Bilateral AOM was induced in chinchillas by transbulla injection of Streptococcus pneumoniae, and TMs were perforated with a CO2 laser 3 to 5 days later. Each animal received ciprofloxacin-dexamethasone in one ear and ciprofloxacin in the other, twice daily for 7 days. Tympanic membranes were assessed for 4 weeks. Fifteen of 55 ciprofloxacin-treated and 37 of 55 ciprofloxacin-dexamethasone-treated TMs failed to heal within the 4-week study period (p < 0.001). Exposure to dexamethasone increased the odds for persistent perforation by 5.5 (95% confidence interval, 2.4-12.6). At 4 weeks, mean TM perforation diameter was 0.9 mm in ciprofloxacin-treated ears and 2.1 mm in ciprofloxacin-dexamethasone-treated ears (p < 0.001). Topical dexamethasone hinders TM healing in a chinchilla model of AOM at short-term follow-up. Longer follow-up is needed.