SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/10/04

Montelukast treatment effects on the effusion of Otitis media

Summary

Background - Otitis media with effusion (OME) is a common and sometimes persistent problem in young children. Some investigators have found increased levels of the cysteinyl leukotrienes (Cyst L) in the effusion fluid in some cases of OME.

Findings - Combs carried out a randomized, double blind controlled comparison of treatment with montelukast (Mont) a Cyst L antagonist (n=29) or placebo (n=30), given daily for 30 days after an initial 10 day course of amoxicillin in children ages 2-12 years with OME. The presence of a middle ear effusion was documented before and after the Mont vs placebo therapy by tympanometry and acoustic reflectometry. After the 30 day treatment period, the effusion had cleared in 58% of the Mont- treated but in only 16% of the placebo-treated children. These differences were significant.

Reference
Clin Pediatr 2004;43:529-33

Editor's Comments
I discussed this report with Dr. David Skoner of the Allegheny Medical Center in Pittsburgh, PA, an expert investigator of OME. He felt that the findings were provocative, were supported by prior experimental animal findings in which injection of Cyst L into the middle ear induced a picture similar to OME. However, a definitive conclusion will have to await findings in a larger, well-controlled trial of Mont in humans with well-defined OME.

 

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