Efficacy of vitamin A in experimentally induced acute otitis media
Vitamin A plays a role in the prevention of oxidative tissue damage. In the present study we investigated therapeutic role of this substance on healing of middle ear mucosa in experimental acute otitis media (AOM).
Otitis media was induced by inoculating Streptococcus pneumoniae via transtympanic injection. Thirty rats were divided into two groups. Group I treated with parenteral ampiciline-sulbactam. Group II received same antibiotic regimen and parenteral single dose of 100,000 IU vitamin A in palmitate form. At tenth day post-inoculation, animals were sacrificed and mucosal samples were excised from the infected tympanic cavities for histpathological examination and blood samples were obtained for measurements of activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and evaluation of levels of malondialdehyde (MDA) and nitric oxide (NO).
All the infected middle ear mucosas displayed various degrees of the inflammation, but there was no meaningful difference between two groups. However, epithelial integrity was significantly better in group II than group I (p<0.01). While serum NO and MDA levels decreased in the group receiving both antibiotic and vitamin A, serum SOD and GSH activity were found to increased. All of the statistical differences are significant.
Pretreatment with vitamin A increases antioxidant enzyme activities and reduces formation of NO and MDA. Vitamin A may be considered as an additional medicament for the medical treatment of AOM.
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ABSTRACT: Ear disease is a major health problem in poorly resourced countries. The role of nutritional deficiencies in its pathogenesis and in relation to chronic suppurative otitis media (CSOM) has not been reviewed previously.
A systematic review was undertaken using Pubmed, SCOPUS, Cinahl on Ovid, the Cochrane Database and selected medical journals, with no language restriction. Nutritional mechanisms potentially related to ear disease and CSOM risks were reviewed. All studies (observational, case-control, cohort and clinical trials including randomised controlled trials) with nutrition-related information were included. The titles and/or abstracts of all retrieved studies were reviewed and full articles were obtained for relevant studies. Exclusion criteria were multiple publication or studies which did not report nutritional information.
Supplementation studies using single micronutrients and vitamins to determine efficacy in reducing acute or chronic otitis media provided some evidence for an association of middle-ear pathology with deficiencies of zinc or vitamin A. Multi-micronutrient supplementation studies provided further support for a beneficial effect, although the number of studies was small and they were heterogeneous and uncontrolled. No human study was identified which specifically examined the association between copper, selenium or vitamin D status and middle-ear disease or infection.
Particularly in developing countries, research on micronutrient status and vitamin deficiency and their influence on middle-ear disease is required to improve knowledge of the pathogenesis of middle-ear infection and to determine the relevance of nutritional interventions in prevention and treatment.
Available from: Joseph P Pillion
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ABSTRACT: To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood.
Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation.
South central, rural Nepal.
2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006.
Every four months for 16 months preschool children were visited at home, given an oral 200,000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears.
Prevalence of mild or worse hearing loss (≥ 30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient).
During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood.
In undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.
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