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Kufa Med. Journal 2008. Vol. 11. No.1
495
Efficacy of Garlic oil in Treatment of Active Chronic
Suppurative Otitis Media
Sajad Alhelo* MBChB DLO FICMS, MD-CABS (ORL-HNS)
Ahmed M. Al-Abbasi* MBChB, FICMS
Zahraa K. Saeed***BSc
*Consultant otorhinolaryngology Kufa College of Medicine
**Assistant professor of Otorhinolaryngology Basrah College of Medicine
Basrah-Iraq
***Dentistry college-Basrah university ﺔﺻﻼﺧﻟا: ﻰـﻟإ طﺎﺑـﺷ رﻬـﺷ نـﻣ لوﻷا نـﻣ دـﺗﻣﻣﻟا ﻪ ﻧﻣزﻟا رﺗﻔﻟا ﻲﻓ فﺟﻧﻟا ﻲﻓ تﻣﺗ فﻋﺎﺿﻣ وﺣﻧ ﻰﻠﻋ ةروظﻧﻣ ﺔﺳارد ذﻫ
لوأ نرﺷﺗ رﻬﺷ نﻣ ن ﺛﻼﺛﻟاو يدﺎﺣﻟا٢٠٠٥. ﺔﺳاردﻟا تﻧﻣﺿﺗ٤٨ طﺷﺎﻧﻟا نﻣزﻣﻟا ﻰطﺳوﻟا نذﻷا بﺎﻬﺗﻟﺎﺑ ًﺎﺑﺎﺻﻣ ًﺎﺿرﻣ ، ﺔـﻟﺎﺣ لـﻛﻟ ﻲـﺿرﻣﻟا ﺦرﺎـﺗﻟا ذـﺧأ مﺗوﻟا ﻊﻣنذﻸﻟ لﻣﺎﻛﻟا صﺣﻔ ،ﺎـﻬﺗﻋارز تـﻣﺗو ﻲـﻧذﻷا زارـﻓﻹا نﻣ تﺎﺣﺳﻣ تذﺧُأو ، ﻊﻣـﺳﻟا صـﺣﻔﻟ ﺔـﻟﺎﺣ لـﻛ عوـﺿﺧ ﻊـﻣنﻋوﺑﺳأ رﺗﻔﺑ دﻌﺑو جﻼﻌﻟا لﺑﻗ ،ن ﻠﺳﺳﻛوﻣﻷا نﻣ ﺔﺑﺳﺎﻧﻣ عرﺟﺑ ًﺎزﺎﻬﺟ اوﺟﻟوﻋ ﻰﺿرﻣﻟا ﻊ ﻣﺟ ّ
نأ ًﺎﻣﻠﻋ. ا تﻻزـــــﻌﻟا نـــــﻣ ًﺎﻋو ـــــﺷ رـــــﺛﻛﻷا ﻲـــــﻫ ﺔـــــ ﺑﻫذﻟا ﺔـــــ دوﻘﻧﻌﻟا تاروـــــﻛﻣﻟا ّ
نأ ن ـــــﺑﺗ ﺔﻠـــــﺻﺣﺗﺳﻣﻟ)٢٥ (% لـــــﻛ لﻛـــــﺷو
pseudomonas aeroginosa streptococcus pneumoniae ﺔﺑﺳﻧ نﻣ)١٨.٧ (%تﻻزﻌﻟا نﻣ. نذﻸﻟ تارطﻘﻛ موﺛﻟا تز مدﺧُﺗﺳا دﻘﻟ ، ن ـﺳ ﺎﻣوﻧﻟا تارطﻗو– نوزﺎﺛ ﻣﺎـﺳﻛد ،ﻲـﺣﻠﻣﻟا لوـﻠﺣﻣﻟا تارـطﻗو)٩(% ، ﻰﺿرﻣﻟا نﻣ ﺔوﺎﺳﺗﻣ ﻊ ﻣﺎﺟﻣ ﺔﺛﻼﺛ ﻰﻠﻋ ًﺎ ﺋاوﺷﻋ تﻋزوو. ـﻟ لﻣﺎﻛ نﺳﺣﺗ ﻰﻟإ ىدأ موﺛﻟا تز مادﺧﺗﺳا ّ
نإ)٨١ (% نﺳﺣﺗﻟا نﺎﻛ ﺎﻣﻧ ﺑ ،ﻰﺿرﻣﻟا نﻣ)٦٩ (% ن ذـﻟا ﻰﺿرﻣﻠﻟ ن ـﺳ ﺎﻣوﻧﻟا تارطﻗ اوﻣدﺧﺗﺳا- نوزﺛ ﻣﺎـﺳﻛد ، ﻲـﺣﻠﻣﻟا لوـﻠﺣﻣﻟا مادﺧﺗـﺳاو)ن ﻼـﺳ لﺎـﻣروﻧ ( نـﺳﺣﺗ ﻰـﻟإ ىدأ)٢٥ (% ﻰﺿرﻣﻟا نﻣ. نﺳﺣﺗ ﻰﻟا ىدا موﺛﻟا تز تارطﻗ مادﺧﺗﺳا نا رﻬظ دﻘﻟنرﺧﻵا ن ﺟﻼﻌﻟﺎﺑ ﺔﻧرﺎﻘﻣ تﻻﺎﺣﻠﻟ رﻛﺑﻣ. ﺔﺛﻼﺛﻟا تﺎﺟﻼﻌﻟا نﻣ يأ مادﺧﺗﺳﻻ ﺔﺟ ﺗﻧ تﺎﻔﻋﺎﺿﻣ ﺔأ لﺟﺳﺗ مﻟ.
Abstract:
This is a double-blind prospective study done in Najaf, during 1st of February to the
31st of October 2005.
Fourty- eight patients with active chronic suppurative otitis media were included in
this study, full history ,otological examination, ear swab for culture were done as well as
pure tone audiometry performed before and 2 weeks after treatment. All the studied
patients treated systemically by appropriate dose of amoxicillin.
The commonest isolated organism was staphylococcus aureus (25%), followed by
pseudomonas aeroginosa and streptococcus pneumoniae (18.7%) for each.
Kufa Med. Journal 2008. Vol. 11. No.1
496
Garlic oil ear drops, neomycine dexamethason (neodexone) drops and normal saline
9% were used as local therapy (ear drops) randomly for the three equally divided groups
of patients.
The use of Garlic oil ear drops associated with 81% complete improvement compared
with 69% improvement by neomycin –dexamethason drops and only 25% for normal
saline drops, the interesting fact that improvement by the use of Garlic oil ear drops
occurred earlier than the use of neomycin – dexamethason and normal saline ear drops.
No complication was detected as a result of treatment by any of the above treatment.
Introduction:
Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear,
defined as otorrhoea of at least 2 weeks duration in the presence of tympanic membrane
perforation.(1)
Active CSOM forms a major proportion of the clinical work load of an average
otolaryngological practice.(2)
Ototopical antibiotic treatment is more effective than systemic antibiotic therapy in
eliminating otorrhoea in chronic suppurative otitis media(2-5), probably because
irreversible tissue damage and fibrosis caused by infection renders systemic therapy less
effective.
Neomycin is particularly valuable against Proteus and Staphylococcus aureus but is
ineffective against Gram-negative, anaerobes and has limited action against
Pseudomonas aeroginosa because of an increasing degree of resistant; the presence of
steroid with an antibiotic drop enhances the efficacy of the antibiotic.(6)
The ancient Indians, Chinese, Egyptians, Greeks, Romans, and otherpeoples have used
garlic for thousands of years, as food and as medicine. One of the most famed usages of
garlic was during the Middle Ages, when it was reputed to have been highly effective
against the plague.(7)
As early as 1858, Louis Pasteur formally studied and recorded garlic's antibiotic
properties. Dr. Albert Schweitzer used the herb to successfully treat cholera, typhus, and
dysentery in Africa in the 1950s. Before antibiotics were widely available, garlic was
used as a treatment for battle wounds during both World Wars.(7)
Garlic (Allium sativum). Garlic, also known as poor man's or Russian penicillin, is found
in many kitchens throughout the world.(8)
Standardized garlic doses include sulfur and allicin compounds. Allicin is the
substance that gives garlic its antibiotic qualities. The sulfur compounds give garlic its
familiar smell.(9)
Side effects include "fragrant" breath, rare instances of GI symptoms, changes to
intestinal flora, and allergic reactions. Surgical patients consuming large quantities of
garlic may experience increased blood loss with or without the use of additional blood
thinners, aspirin, or NSAIDs, because of prolonged clotting times.(10)
Aim of the study: The aim of this study is to throw some light on the efficacy of Garlic
oil ear drops in medical treatment of chronic suppurative otitis media.
Patients and methods:
Kufa Med. Journal 2008. Vol. 11. No.1
497
This is a double blind randomized prospective study, done in otolaryngology
department in assadr teaching hospital in the period from the 1st of February to the 31st of
October 2005.
Forty-eight patients exhibiting otorrhoea-associated recurrent suppurative otitis media
with tympanic membrane perforation were included in this study, their ages ranged from
11 to 67 years with mean age of 26 years, more than this number of patients was seen
but they excluded because of cholesteatoma, marginal perforation, impending
complication, aural polyps, associated otitis externa and children below 10 years. Swabs
for culture were taken from all the studied patients, pure tone audiometry also done
before and 2 weeks after local treatment.
All the studied patients were treated systemically by the appropriate dose of
amoxicillin.
Garlic oil ear drops, neomycin-Dexamethason (Neodexon) and normal saline (9%), put
in identical darkly brown bottles, labeled with code number only, were randomly given
to the 3 studied groups (each one included 16 patients), the dose was 3 drops, three times
daily for 2 weeks, before which they instructed to clean the ear by self-made cotton buds,
the patients also informed to prevent water from gaining access into the ear, Assessment
was based on symptomatology and examination which is done after the 1st and 2nd weeks
of treatment.
I suggest a simple score for assessment of improvement, including tinnitus, amount of
ear discharge, types of discharge, middle ear mucosal congestion and oedema, and
hearing threshold represented by air-bone gap. (ABG), completely improved patients
should have 8-10 mark, partial improvement 4-7, no improvement 0-3 and worsen
condition below 0.
The proposed scoring system
Parameters
Tinnitus
No
2
Decrease
1
Same
0
Increase
-
1
Amount of
discharge No 2 Decrease 1
Same 0
Increase or
pulsatil -1
Type of discharge
No
2
Mucoid
1
Mucopus
0
Purulent
-
1
mu
cosal congestion
No
2
Mild
1
Same
0
Increase
-
1
Air
-
bone gap by
PTA
Significant
decrease 2
Insignificant
decrease 1
Same 0
Increase
gap -1
Results:
The results of cultures of ear swabs of the studied patients are shown in table I.
Staphylococcus aureus was the commonest organism, observed in 12(25%) patients,
followed by pseudomonas and streptococcus pneumonia 9(18.7%) patients for each. In
nine patients no growth was detected.
Table (I): Types of organism in patients with CSOM
Type of organisms
No.
%
Staphylococcus aureus
12
25
Pseudomonas aeroginosa
9
18.75
Streptococcus pneumonia
9
18.75
Proteus sp
4
8.33
Kufa Med. Journal 2008. Vol. 11. No.1
498
Bacteriology of CSOM in diffirent studies
0
5
10
15
20
25
30
35
Present study
Sugita et al.
Constable and Butler
Brook
Studies
% of organisms
Staph. aureus
Pseudomonas
Strepto
Proteus
Kleb.
E. coli
Klebsiella sp
3
6.25
E. coli
2
4.16
No growth
9
18.75
Total
48
100
Table II shows the improvement of CSOM according to different local therapy.
Eighty-one percent of those treated by Garlic oil ear drops were improved completely,
while only one patient (6%) not improved and no patients underwent worsen in his or her
condition, eleven patients who comprises 69% of those used Neodexon drop were
completely improved, and 3 patients (19%) partially improved but in only 12% of
patients there were no changes in their condition had been occur. Normal saline drop
show discouraging result that is only 4 patients (25%) showed complete improvement,
but in 10 patients there were no change of their condition (62%).
Table (II): Improvement according to different type of local therapy
Drug
Improvement
Garlic oil
Neodexon
Normal saline
No.
%
No.
%
No.
%
Completely improved
13
81
11
69
4
25
Partial
improvement
2
12
3
19
2
12
Same condition
1
6
2
12
10
62
Worsen condition
0
0
0
0
0
0
Total
16
16
16
P – Value Chi - square
Discussion:
Histogram I shows the organism cultured in different studies 5, compared to our study,
the difference may attributed to the previous wrong self use of antibiotics which change
the environment of organisms. The causes behind negative culture in 9 patients probably
due to anaerobic infection, laboratory error or due to antibiotics taken before culture.
Histogram I: comparison of bacteriology of CSOM in different studies
Kufa Med. Journal 2008. Vol. 11. No.1
499
Improvement expressed as cure of otorrhoea and middle ear mucosal
inflammation.(11,12) The use of Garlic oil ear drops associated with 81% complete
improvement (13 patients) after the treatment course, and the interesting fact is that
improvement occurred earlier than the use of Neodexon drops and normal saline.
The antimicrobial activity and other medical benefits of garlic oil have been widely
recognized.(13-15) These benefits have been attributed to the presence of sulphides in
garlic oil.(14,15) Because they are easy to obtain or prepare as well as having good
stability, the medical properties of the garlic constituents diallyl monosulphide and
diallyl disulphide have been the focus of many studies.(16-19) A chemical analysis of
garlic oil showed that 54.5% of the total sulphides comprised diallyl monosulphide,
diallyl disulphide, diallyl trisulphide and diallyl tetrasulphide 20. Although diallyl
trisulphide and diallyl tetrasulphide accounted for 26.6% of the total sulphides in garlic
oil, little attention has been paid to the medical benefits of these two components. The
inhibitory effect of diallyl disulphide, but not diallyl monosulphide, against C. Albicans
has been reported previously 21; however, information regarding the activity of these
two agents against Aspergillus spp. and MRSA is limited. The antimicrobial activity of
garlic extract against S. aureus has been observed 22; however, whether garlic oil can
inhibit MRSA and fungal pathogens remains unknown. Also, the compounds in garlic oil
responsible for any inhibitory effect require further elucidation.
In the present study there were no any signs, symptoms or pure audiometric features of
ototoxicity resulted from Garlic oil ear drops therapy.
No allergic reaction was reported during the use of Garlic oil ear drops in this study.
In conclusion, Garlic oil ear drops probably highly recommended in medical treatment
of active CSOM but this needs further confirmation by other extended studies.
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