Intranasal surfactant aerosol therapy for otitis media with effusion

Objective: To determine the effect of surfactant alone and with other medic ations delivered intranasally as a metered dose inhaler (MDI) aerosol on th e resolution of experimentally induced otitis media with effusion (OME). Ba ckground: Eustachian tube dysfunction is a primary factor in the pathogenes is of OME, Intranasal surfactant via MDI has been shown in this laboratory to reduce passive opening pressure of the eustachian tube in normal gerbils and mice. Study Design: OME was developed in 35 gerbils by transtympanic i njection of 10 mug lipopolysaccharide from Klebsiella pneumoniae, Pretreatm ent otomicroscopy and tympanometry were performed to exclude pre-existing m iddle ear disease, and postinfection evaluations were performed on alternat e days for a period of 30 days. Five animals received no treatment (control group); four were treated with propellant only (placebo); seven received s urfactant alone; eight received surfactant and betamethasone; and six recei ved surfactant with phenylephrine, All medications were sprayed intranasall y as an aerosolized MDI and administered daily from postinfection day 2 onw ard. Results: OME resolved after 16.0 +/- 0.44 days (mean +/- SD) in contro ls. There was no difference seen in the placebo or the surfactant with phen ylephrine groups. Treatment with surfactant yielded resolution in 10.57 +/- 0.37 days; this was reduced to 8.57 +/- 0.37 days with surfactant plus bet amethasone. These differences are statistically significant. There was no r ecurrence of OME in any group, Conclusion: This study demonstrates that usi ng an aerosolized MDI surfactant with and without betamethasone decreases t he duration of OME in this in vivo gerbil model.