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 TREATMENT OF EXTERNAL AUDITORY CANAL INFLAMMATION WITH NELADEX 
MIKHEIL JASHI, M.D., Ph. D Associate Professor
Tbilisi State Medical University. Department of Otorhinolaryngology.
(Head of department Professor Sh. Japaridze)
 
The treatment of the external auditory canal inflammation is still the actual theme in the modern otorhinolaryngology. This is explained by many reasons: High prevalence of the disease (Inflammation of external auditory canal comprises 25-30% of all ear diseases),high frequency of inadequate therapy and unfavorable outcomes, and high risk of the otomycoses development.(1)  
The clinical picture of external auditory canal diseases changed and complications decreased with the usage of antibiotics and sulfanilamides over the last decades. Based on the statistical data, frequency of these diseases greatly decreased with beginning of the antibiotic era and was in steady state for 20 years, but the incidence of external ear diseases is increasing again for the last years. It is caused by worsened environmental factors and uncontrollable usage of medications, which causes immunological changes and the increase in allergic tendencies of the body. The consensus is not reached about the causative microorganism of external auditory canal inflammation. Part of authors think that fungal infection is the main cause of the disease, and the others consider it as the secondary factor. According to some study reports bacterial infection causes 64,2% of all dermatitis of the external auditory canal(Staphylococcus aureus is the leading causer about 46% of the cases), and fungal infection comprise only 28% of the diseases and in the rest of the cases the infection is caused by mixed flora.(2,3,4) 
The mentioned above shoes the need of the development of a new and more effective treatment method. Number of topical preparations is limited. We can apply some drugs such as Gioxizone, Otinum, Sofradex and etc. The main shortcoming of these medications is that their main field of action is pain relief and have poor antibacterial effect.
This article describes the experience in using Neladex for the external auditory canal inflammation.
The leading symptom of external otitis is itching in the external auditory canal and the pain with the irradiation to the temporally region, dumped hearing and sometimes discharge develops later. On physical examination the ear canal appears constricted, hyperemic and may be covered with dry plaques, often the epidermic layer of the eardrum is also involved in the process.(5)  
Neladex is a complex medication with antibacterial, anti-inflammatory and antiallergic actions. It contains dexamethasone, synthetic corticosteroid, which reduces synthesis of inflammatory and allergic mediators. Due to combination of two antibiotics of different groups, Neladex has the broad spectrum antibacterial activity: Neomycin sulfate is the first generation aminoglycoside, with broad spectrum antibacterial and bactericidal action. Polymyxin B sulfate is a polypeptide antibiotic, with the main effect on the gram- negative organisms.
Neladex is used in otorhinolaryngology for the treatment of acute and chronic external otitis and  otitis media  (without perforation).
We conducted study on 30 patients and 20 controls with outer ear inflammation. There were men and women of 19-50 years in both groups and all of them were treated on the outpatient basis. Controls were treated with Gioxizone. Gioxizone was chosen because of similar ingredients – oxitetracycline hydrochloride 3% and hydrocortison acetate 1%. 
The effectiveness of the treatment was evaluated on second, fourth and sixth days on the basis of
ear ache
hearing deficiency
otoscopic picture dynamics.
 
All patients treated with Neladex did not have ear ache on the second day of treatment and the hearing was improved on the fourth day. Otoscopic image was normalized on the sixth day. In the control group improvement began 1-2 days later. There were no side effects of Neladex in the main group.
The conducted study showed that Neladex is very effective for the treatment of the outer ear inflammation. There is tendency of much faster recovering from the disease with Neladex than with other traditional treatment methods, the reason of which, probably is the high sensitivity of microorganisms for the components of Neladex.
 

References:
1.      Орлов A.B., Иваненко А.М. “Современные методы лечения дерматитов наружного слухового прохода”Актуалъные вопросы оториноларингологии детского возраста и фармакотерапия болезней лор-органов, Москва 2001,с.80-84
2.      Maher A., Bassiouny A. et all “Otomycosis: an experimental evaluation of six antimycotic agents” L.Laryng, 1982.6p.82-83
3.      Neher A., Nagl M.et all “Acute otitis externa: efficacy and tolerability of N-chlorotaurine a novel endogenous antiseptic agent” Laryngoscope 2004; 114 (5):850-4
4.      Ong YK., Chee G. “infections of the external ear” Ann Acad Med Singapore 2005; 34(4): 330-4
5.      Ballenger J.J. “Diseases of the nose, throat, ear, head, an neck” Lea and Febiger, Philadelphia London 1991, p. 1104-1105