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Cotrimoxazole in the treatment of serous otitis a follow-up report

Introduction Various different forms of conservative treatment for serous otitis media (SOM) have been advocated by different authors. Hunt Williams (1968) and Shea (1971) have described different methods of auto-inflation of the middle ear by patients. They claimed a successful outcome, particularly in 'mild' cases of SOM. However, Fraser, et al. (1977), in a controlled trial, found no difference between this form of treatment and placebo. Antihistamine and decongestant preparations, such as chlorpheniramine maleate with phenylephrine and phenylpropanolamine ('Dimotapp'), have been widely used without any published evidence of their effectiveness. Again, Fraser et al (1977) found no difference between 'Dimotapp' and placebo in their trial. Miller (1970) studied a group who had had grommets inserted for SOM. He demonstrated an improvement in eustachian tube function following treatment with a decongestant preparation (Carbinoxamine/pseudoephedrine). He did not, however, investigate the effect of this preparation on the course of the disease. Bain (1981) described a survey of 274 children with acute otitis media. He showed that those who suffered recurrent episodes have a higher incidence (36 per cent) of atopy in their history. Interestingly, despite this, the majority who went on to develop SOM had no history of atopy. Whilst there is evidence that atopy is important in SOM, as yet no treatment aimed at this casual factor has been shown to be effective. Taylor and Dereshani (1975) noted that 34 per cent of their cases of SOM improved on treatment with S-carboxy-methylcysteine syrup (Mucodyne), as compared with only six per cent who received placebo. Ramsden et al (1977), however, found no such difference in a similar controlled trial (Mucodyne, 38 per cent; placebo, 26 per cent). Marks et al. (1981) compared the effects of cotrimoxazole and'Dimotapp' on SOM in a controlled trial. 64 per cent of the group treated with cotrimoxazole had improved after six weeks, as compared with 26.9 per cent treated with 'Dimotapp'. The present study reports the longer-term outcome in these children.