4. Discussion
OME
MIDDLE EAR, PATHOLOGY, PATHOGENESIS
To the best of our knowledge, this study is the first trial of inhaled mucolytics and steroids in adults with OME, in whom tympanometry was assessed at baseline and after treatment. We found high rates of improvement in tympanometry after three days of treatment. Following AMSA administration, we observed significant improvement in volume, pressure, and compliance measured in tympanometry. No significant differences in response to treatment were observed for patients’ age, sex, or season of inclusion.A short course of AMSA with a nebulized mucolytic drug and steroid in OME could be regarded as an effective treatment alternative. Moreover, it avoids more disruptive and costly interventions such as myringotomy and grommet insertion. Previous research showed some evidence in favor of AMSA use for OME treatment in children under the age of 18 years. The characteristics and results of previously published studies using AMSA are summarized in These studies vary in the duration of treatment, medication, and outcome assessment methods. In contrast to the other studies that included children, as noted previously, our focus is on the adult population. While the length of intervention in previous studies was at least 5 days, our study demonstrated that a three-day course may also result in a clinical benefit. The reduced duration of treatment was possible due to the adults’ facilitated cooperation and more comprehensive implementation of instructions as compared to the children. Each of the previous studies used a different medication protocol—mucolytics alone [The drugs applied in AMSA are generally steroids combined with a mucolytic drug, saline, or an antibiotic. Locally applied steroids via pulsatile airflow have been shown to facilitate ventilation efficiency and ensure appropriate medication distribution to hard-to-reach areas [Studies adopting Politzer insufflations or nasal lavage can be a source of concepts for new AMSA drug protocols. Mirandola et al. reported a clinical improvement of OME in children after Politzer insufflations of sulphurous water, which they compared to the untreated control group [No single perfect method for evaluating the state of the middle ear currently exists. Most studies use pure tone audiometry [The condition of the ET has been linked to OME pathogenesis [Our study is not free of limitations. First, this study did not involve a control group. Secondly, the study sample was relatively small, but its pilot character explains this. Patients did not receive a disease-specific quality-of-life questionnaire, nor undergo imaging to exclude nasopharyngeal or anterior/middle cranial fossa pathology, possibly impairing ET function. No pure tone audiometry nor another hearing test before and after the intervention were performed. Moreover, we did not consider a long-term follow-up visit after the end of the intervention. Clearly, larger, controlled clinical studies need to be conducted to confirm our results.An undoubtful strength of this study is that it is the first report of AMSA use in OME management in adults. Observed effect sizes can be further utilized in the calculation of a minimum sample size in future studies.