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Topical 5-fluorouracil for granular myringitis: a double-blinded study

Published online by Cambridge University Press:  11 December 2009

A M Atef*
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
M M Hamouda
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
A H A Mohamed
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
A F A Fattah
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
*
Address for correspondence: Dr A Atef, 7 Mahmoud Afifi Street, Almaza, Cairo, Egypt11341. Fax: 0020224193790 E-mail: [email protected]

Abstract

Background:

Granular myringitis is a poorly understood disease which causes considerable discomfort and concern to affected individuals. Some cases may progress to inflammatory obliteration of the deep ear canal. Treatment options are diverse, and no single accepted treatment modality exists. Local application of 5-fluorouracil has recently been trialled in the treatment of chronic otitis media, with promising results.

Aim:

To investigate the efficacy and safety of topical 5-fluorouracil in cases of granular myringitis.

Methods:

Sixty patients with granular myringitis were enrolled in this controlled, double-blinded study. Patients were divided randomly into two equal groups. Patients in the study group (n = 30) received three successive applications of topical 5-fluorouracil 5 per cent cream, with two-week intervals between treatments. Patients in the control group (n = 30) received only local petroleum jelly cream packing at the same intervals. Follow-up appointments were scheduled every two weeks for the first three months; patients were then seen again after two years for evaluation of any persistent disease. Outcome measures were: (1) after three months, symptomatic response to treatment (i.e. quantity of aural discharge as reported by patient) and change in the amount of granulation tissue (as assessed by the physician via endoscopic examination); and (2) persistent disease after two years.

Results:

There was a highly statistically significant difference in the studied outcomes, comparing the study and control groups.

Conclusion:

Local application of 5-fluorouracil is a new treatment method for granular myringitis. In this study, it proved safe and efficacious, with no serious local reactions or complications.

Type
Main Article
Copyright
Copyright © JLO (1984) Limited 2009

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References

1Schuknecht, HF. Pathology of the Ear. Cambridge, Massachusetts: Harvard University Press, 1974;218Google Scholar
2Levinson, RM. The management of granular myringitis and retraction pockets. In Surgery of the Ear & Temporal Bone. New York: Raven Press, 1993;139–44Google Scholar
3Blevins, NH, Karmody, CS. Chronic myringitis, prevalence, presentation and natural history. Otol Neurotol 2001;22:310CrossRefGoogle ScholarPubMed
4Wolf, M, Primov-Fever, A, Barshack, I, Polack-Charcon, S, Kronenberg, L. Granular myringitis incidence and clinical characteristics. Otol Neurotol 2006;27:1094–7CrossRefGoogle ScholarPubMed
5Khalifa, MC, El-Fouly, S, Basssiouny, A, Kamel, M. Granular myringitis. J Laryngol Otol 1982;96:1099–101CrossRefGoogle ScholarPubMed
6Makino, K, Amatsu, M, Kinishi, M, Mohri, M. The clinical features and pathogenesis of myringitis granulose. Arch Otolaryngol 1988;245:224–9Google Scholar
7Stoney, P, Kwok, P, Hawke, M. Granular myringitis: a review. J Otolaryngol 1992;21:129–35Google ScholarPubMed
8El-Seifi, A, Fouad, B. Granular myringitis. Am J Otol 2000;21:462–7Google ScholarPubMed
9Smith, MF. The topical use of 5-fluorouracil in the ear in the management of cholesteatoma and excessive mucous secretion. Laryngoscope 1985;95:1202–3CrossRefGoogle ScholarPubMed
10Miller, E. The metabolism and pharmacology of 5-fluorouracil. J Surg Oncol 1971;3:309–15CrossRefGoogle Scholar
11Heidelberger, C, Ghobar, A, Baker, RK. Studies of fluorinated pyrimidines X. In vivo studies on tumor resistance. Cancer Res 1960;20:897902Google ScholarPubMed
12Goette, DK. Topical chemotherapy with 5-fluorouracil. J Am Acad Dermatol 1981;4:633–49CrossRefGoogle ScholarPubMed
13Perrett, CM, McGregor, JM, Warwick, J, Karran, P, Leigh, IM, Proby, CM et al. Treatment of post- transplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy. Br J Dermatol 2007;156:320–8CrossRefGoogle ScholarPubMed
14Smith, HG, Healy, GB, Vaughan, CW, Strong, MS. Topical chemotherapy of recurrent respiratory papillomatosis. A preliminary report. Ann Otol Rhinol Laryngol 1980;89:472–8CrossRefGoogle ScholarPubMed
15Takahashi, H, Funabiki, K, Hasebe, S, Fukuda-Yamamoto, T, Kaieda, S, Iwanaga, T et al. Clinical efficacy of 5-fluorouracil (5-FU) topical cream for treatment of cholesteatoma. Auris Nasus Larynx 2005;32:353–7CrossRefGoogle ScholarPubMed
16Jung, HH, Cho, SD, Yoo, CK, Lim, HH, Chea, SW. Vinegar treatment in the management of granular myringitis. J Laryngol Otol 2002;116:176–80CrossRefGoogle ScholarPubMed
17Iwanaga, T, Tanaka, F, Tsukasaki, N, Terakado, N, Kaieda, S, Takasaki, A et al. Does topical application of 5-fluorouracil ointment influence inner ear function? Otolaryngol Head Neck Surg 2006;134:961–5CrossRefGoogle ScholarPubMed
18Yamamoto-Fukada, T, Terakado, M, Hishikawa, Y, Koji, T, Takahashi, H. Topical application of 5-fluorouracil on attic cholesteatoma results in downregulation of keratinocyte growth factor and reduction of proliferative activity. Eur Arch Otolaryngol 2008;265:1173–8CrossRefGoogle Scholar