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Topische Immunmodulation

Ein Meilenstein in der Behandlung der therapieresistenten nichtinfektiösen chronischen Otitis externa?

Topical immunomodulation

A milestone for the treatment of therapy-resistant noninfectious chronic external otitis?

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Zusammenfassung

Hintergrund

Rezidivierende Exazerbationen bei chronischer Otitis externa stellen für den Behandler eine besondere Herausforderung dar. Untersucht werden sollte die therapeutische Wirksamkeit einer neuen Klasse von lokal applizierbaren Immunmodulatoren mit antiinflammatorischem, nichtsteroidalem Wirkmechanismus.

Patienten und Methoden

In einer prospektiven Studie an 33 Patienten erfolgte alle 2 (–3) Tage eine Streifeneinlage mit Tacrolimus-Salbe (Protopic® 0,1%), insgesamt 3-mal ein Streifenwechsel. Der Behandlungserfolg wurde durch Nachuntersuchungen, anhand einer Videodokumentation und eines standardisierten Befundbogens beurteilt.

Ergebnisse

28 Patienten zeigten eine signifikante Verbesserung der klinischen Symptomatik, 13 von ihnen eine komplette Heilung (Follow-up: 10–22 Monate). Bei Rezidiven (15 Fälle) waren die symptomfreien Intervalle signifikant verlängert und die Anzahl weiterer Episoden verringert.

Schlussfolgerung

Dank ihrer sicheren und erfolgreichen antientzündlichen Wirkung stellen topische Immunmodulatoren eine neue Alternative bei chronisch therapieresistenter Otitis externa dar.

Abstract

Background

Recurrent exacerbation of chronic external otitis represents a special challenge for the attending physician. The goal of our study was to evaluate the effectiveness of novel topical immunomodulators acting through an anti-inflammatory, nonsteroidal mechanism.

Patients and Methods

In a prospective study, in 33 patients an ear wick containing tacrolimus ointment (Protopic 0.1%) was inserted every 2–3 days. Altogether, the wick was changed three times. Therapeutic outcomes were assessed by reexaminations, video-otoscopy, and a standardized findings sheet.

Results

Twenty-eight patients showed significant improvement of clinical symptoms, with 13 of them showing complete healing (follow-up 10–22 months). Relapses (15 cases) were associated with significantly extended symptom-free intervals and reduced numbers of further recurrent episodes.

Conclusions

Because of the safe and successful anti-inflammatory effects, topical immunomodulators represent a new alternative in chronic inflammatory stages of otherwise therapy-resistant external otitis.

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Interessenkonflikt

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Authors and Affiliations

  1. HNO-Klinik und Poliklinik , Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    P.P. Caffier, B. Mayelzadeh, H. Haupt, H. Scherer & B. Sedlmaier

  2. Dermatologische Klinik, Vivantes-Klinikum im Friedrichshain, Akademisches Lehrkrankenhaus der Charité – Universitätsmedizin, Berlin, Deutschland

    W. Harth

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  1. P.P. Caffier
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  2. W. Harth
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  4. H. Haupt
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  6. B. Sedlmaier
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Correspondence to P.P. Caffier.

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Danksagung

Dank sei den an der Studie beteiligten HNO-Praxen in Berlin gesagt: R. Tausch-Tremel, R. Lenk, C. Conrad, P. Bohlmann, T. Flöttmann, R. Reinke, A. Jivanjee.

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Caffier, P., Harth, W., Mayelzadeh, B. et al. Topische Immunmodulation . HNO 56, 530–537 (2008). https://doi.org/10.1007/s00106-007-1615-8

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