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Efficacy of Garlic oil in Treatment of Active Chronic Suppurative Otitis Mediaو‬

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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.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
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: ـإ طﺎﺑـ رـ نـ لوا نـ دـﺗﻣﻣﻟا ﻪ ﻧﻣزا رﺗﻔﻟا ﻲﻓ فﺟﻧﻟا ﻲﻓ تﻣﺗ فﻋﺎﺿﻣ وﺣﻧ ﻰﻠﻋ ةروظﻧﻣ ﺔﺳارد ذ
لوأ نر رﻬﺷ ن ن ﺛﻼﺛﻟاو يدﺎﺣﻟا٢٠٠٥. ﺔﺳاردا تﻧﻣﺿﺗ٤٨ طﺷﺎﻧﻟا نزﻣﻟا طوا نذا بﺎﻬﺗﻟﺎﺑ ًﺎﺑﺎﺻﻣ ًﺎﺿر ، ـﻟﺎﺣ لـﻛﻟ ـﺿرﻣﻟا رـﺗﻟا ذـأ موا ﻊﻣنذﻸﻟ لﻣﺎﻛا صﺣﻔ ،ـﻬﺗﻋارز تـﻣﺗو ـذا زارـﻓﻹا ن تﺎﺣﺳﻣ تذُأو ، ﻊﻣـﺳﻟا صـﻔﻟ ـﻟﺎﺣ لـ عوـﺿﺧ ـنوﺑﺳأ رﺗﻔﺑ دﻌﺑو جﻼﻌﻟا لﺑﻗ ،ن ﻠﺳﺳﻛوﻣﻷا ن ﺔﺑﺳﺎﻧﻣ عرﺟﺑ ًزﺎﻬﺟ اوﺟﻟو ﻰﺿرﻣﻟا ﻊ ﻣﺟ ّ
نأ ًﺎﻣﻠﻋ. ا تزـــــﻌﻟا نـــــ ًﺎﻋو ـــــ رـــــﺛﻛﻷا ـــــ ـــــ ﺑﻫذا ـــــ دوﻘﻧﻌﻟا تاروـــــﻛﻣﻟا ّ
نأ ن ـــــﺑﺗ ﺔﻠـــــﺻﺣﺗﺳﻣﻟ)٢٥ (% لـــــ لـــــو
pseudomonas aeroginosa streptococcus pneumoniae ﺔﺑﺳﻧ ن)١٨.٧ (%تزﻌﻟا ن. نذﻸﻟ تارطﻘﻛ موﺛﻟا تز مدُﺗﺳا دﻘﻟ ، ن ـﺳ ﺎﻣوﻧﻟا تارطو نوزﺎﺛ ﻣﺎـﺳﻛد ،ـﺣﻠﻣﻟا لوـﻠﺣﻣﻟا تارـطو)٩(% ، ﻰﺿرﻣﻟا ن وﺎﺳﺗﻣ ﻊ ﻣﺎﺟﻣ ﺔﺛﻼﺛ ﻰﻠﻋ ًﺎ ﺋاوﺷﻋ تزوو. ـ لﻣﺎﻛ نﺳﺣﺗ إ ىدأ موﺛﻟا تز مادﺧﺗﺳا ّ
نإ)٨١ (% نﺳﺣﺗﻟا نﺎﻛ ﺎﻣﻧ ﺑ ،ﻰﺿرﻣﻟا ن)٦٩ (% ن ذـا ﻰﺿرﻣﻠﻟ ن ـﺳ ﺎﻣوﻧﻟا تارط اودﺧﺗﺳا- نوزﺛ ﻣﺎـﺳﻛد ، ـﺣﻠﻣﻟا لوـﻠﺣﻣﻟا مادﺧﺗـاو)ن ـ لـرو ( نـﺳﺣﺗ ـإ ىدأ)٢٥ (% ﻰﺿرﻣﻟا ن. نﺳﺣﺗ ﻰﻟا ىدا موﺛﻟا تز تارط مادﺧﺗﺳا نا رظ دﻘﻟنرﺧﻵا ن ﺟﻼﻌﻟﺎﺑ ﺔﻧرﺎﻘﻣ تﻻﺎﺣﻠﻟ رﻛﺑﻣ. ﺔﺛﻼﺛﻟا تﺎﺟﻼﻌﻟا ن يأ مادﺧﺗﺳﻻ ﺔﺟ ﺗﻧ تﺎﻔﻋﺎﺿﻣ أ لﺟﺳﺗ م.
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
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
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
Streptococcus pneumonia
9
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
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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González-Fandos E, Garcia-López ML, Sierra ML, Otero A. Staphylococcal growth and
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... Garlic is used to treat common viral diseases, such as the common cold, fever, coughs, asthma, and wounds in Asia and Europe (Rehman et al. 2019;Rouf et al. 2020). The oil extracted from garlic has also been used to mitigate the pain of ear infections (Al Abbasi, 2008). In African countries, like Ethiopia and Nigeria, garlic has been used as a traditional remedy for the treatment of several infections, such as sexually transmitted infections, tuberculosis (TB), respiratory system diseases, and wounds due to injuries and damage of different tissues (Gebreyohannes and Mebrahtu 2013;Abiy and Asefaw 2016). ...
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Most studies on garlic during the past 15 years have been primarily in the fields of cardiovascular and cancer research. Cardiovascular studies have been mainly related to atherosclerosis, where effects were examined on serum cholesterol, LDL, HDL, and triglycerides. Although the studies were not consistent in relation to the dosage, standardization of garlic preparations, and period of treatment, most findings suggest that garlic decreases cholesterol and triglycerides levels in patients with increased levels of these lipids. Lowering of serum lipids by garlic ingestion may decrease the atherosclerosis process. The other major beneficial effect of garlic is due to its antithrombotic actions. This field of garlic research has been extensively studied. Garlic extracts and several garlic constituents demonstrate significant antithrombotic actions both in vitro and in vivo systems. Allicin and adenosine are the most potent antiplatelet constituents of garlic because of their in vitro effects. Since both allicin and adenosine are rapidly metabolized in human blood and other tissues, it is doubtful that these compounds contribute to any antithrombotic actions in the body. In addition, ajoene also seems not to be an active antiplatelet principle, because it is not naturally present in garlic, garlic powders, or other commercial garlic preparations. Only a small amount of ajoene can be found in garlic oil-macerates; however, ajoene is being developed as a drug for treatment of thromboembolic disorders. Recent findings on the identification of potent enzyme inhibiting activities of adenosine deaminase and cyclic AMP phosphodiesterase in garlic extracts are interesting, and may have a significant role in the pharmacological actions in the body. Presence of such enzyme inhibitors in garlic may perhaps explain several clinical effects in the body, including the antithrombotic, vasodilatory, and anticancer actions. Epidemiological studies have suggested that garlic plays a significant role in the reduction of deaths caused by malignant diseases. This had led many investigators to examine garlic and garlic constituents for their antitumor and cytotoxic actions both in vitro and in laboratory animals. The data from these investigations suggest that garlic contains several potentially important agents that possess antitumor and anticarcinogenic properties. In summary, the epidemiological, clinical, and laboratory data have proved that garlic contains many biologically and pharmacologically important compounds, which are beneficial to human health from cardiovascular, neoplastic, and several other diseases. Numerous studies are in progress all over the world to develop effective and odorless garlic preparations, as well as to isolate the active principles that may be therapeutically useful.
Article
The anti-initiating properties of allyl sulfides on rat liver carcinogenesis induced by N-nitrosodiethylamine (NDEA) or aflatoxin B1 (AFB1) were evaluated by using a three-step medium-term hepatocarcinogenesis assay. Diallyl sulfide (DAS) or diallyl disulfide (DADS) was added to the diet of rats (2 g/kg) for three weeks, during which NDEA or AFB1 was administered by intraperitoneal injection. The rats were submitted later to eight days of 2-acetylaminofluorene administration and to two-thirds hepatectomy, then to phenobarbital administration. After eight weeks, liver preneoplastic foci expressing the placental form of glutathione S-transferase were detected. The results show that DAS and DADS strongly reduced the number and the size of preneoplastic foci initiated by NDEA and AFB1, but especially by AFB1; DADS is more efficient than DAS. Most likely, the inhibition of the first step of hepatocarcinogenesis by allyl sulfides is related to the modulating effects that these compounds exert on the enzymes involved in activation and/or detoxication of the carcinogens. Our study demonstrated the chemopreventive potencies of dietary allyl sulfides in liver carcinogenesis induced by two potent hepatic carcinogens.
Article
Ajoene, a garlic-derived sulfur-containing compound that prevents platelet aggregation, exhibited broad-spectrum antimicrobial activity. Growth of gram-positive bacteria, such as Bacillus cereus, Bacillus subtilis, Mycobacterium smegmatis, and Streptomyces griseus, was inhibited at 5 micrograms of ajoene per ml. Staphylococcus aureus and Lactobacillus plantarum also were inhibited below 20 micrograms of ajoene per ml. For gram-negative bacteria, such as Escherichia coli, Klebsiella pneumoniae, and Xanthomonas maltophilia, MICs were between 100 and 160 micrograms/ml. Ajoene also inhibited yeast growth at concentrations below 20 micrograms/ml. The microbicidal effect of ajoene on growing cells was observed at slightly higher concentrations than the corresponding MICs. B. cereus and Saccharomyces cerevisiae were killed at 30 micrograms of ajoene per ml after 24 h of cultivation when cultivation was started at 10(5) cells per ml. However, the minimal microbicidal concentrations for resting cells were at 10 to 100 times higher concentrations than the corresponding MICs. The disulfide bond in ajoene appears to be necessary for the antimicrobial activity of ajoene, since reduction by cysteine, which reacts with disulfide bonds, abolished its antimicrobial activity.