[Immunomodulatory therapy in the postoperative period in chronic purulent otitis media].

Abstract

This paper presents the results of the evaluation of cellular and humoral immunity in chronic purulent otitis media (CPOM), as well as cytokine status, and studies the effect of azoximers bromide on the immunity system in CPOM.

Objective: To study the clinical and immunologic effectiveness of azoximer bromide in the postoperative period during tympanoplasty in CPOM patients.

Material and methods: Forty-nine patients with mesotympanitis and epitympanitis were examined. All patients underwent tympanoplasty using Overlay and Underlay techniques. In all patients the state of cellular and humoral immunity was studied by CD-markers, as well as the levels of cytokines - IL-1b, IL-10, IFN-γ, TNF-α. Clinical and immunologic effectiveness of azoximers bromide in the postoperative period during tympanoplasty in CPOM patients was studied on the basis of the analysis of changes in the mentioned immunologic indices and clinical condition of patients.

Results and discussion: All examined patients with mesotympanitis and epitympanitis who underwent surgical treatment had conductive hearing loss of I-II degree. A decrease in the level of CD3/4⁺ and CD3/8⁺ cells, an increase in the level of CD16/56⁺ and CD19⁺ cells, as well as serum levels of proinflammatory cytokines - IL-1b, IFN-γ, TNF-α and C-reactive protein were determined. The inclusion of azoximers bromide into the standard postoperative therapy was accompanied by a tendency to normalization of the most informative indices of the immunity system: immunoregulatory index CD4/CD8, cytotoxicity index CD8/NK and immunoregulatory cytokines IFN-γ/IL-10 index, as well as such an important indicator of the degree of inflammation activity as serum level of C-reactive protein.

Conclusion: The results of evaluation of immunotropic action of this drug, as well as the clinical effect of its use allow to recommend azoximera bromide as an additional means in postoperative treatment and management of patients with CPOM.