V Manual IAPO ingles FIM.indd

might appear, at first glance, to be revival of an old topic, since much has been written in the past and very little in recent years. Despite that the advent of antibiotics has reduced indications for its routine use, myringotomy persists as a frequent intervention in children.1 A consensus on its being of interest in treatment of non-complicated AOM has not yet been reached it has defenders2,3 and detractors4,5 but, considering the recent emergence of bacterial strains with multiple resistances to antimicrobials6-9 a resurgence of use of myringotomy might be predicted. For instance, it was recently assumed that to evaluate antibiotic efficacy in AOM properly during clinical trials – a cutting edge problem – performance of serial myringotomies should be strongly advised.10 These investigators recommended this should be considered the gold-standard in reliably evaluating eradication of the infectious agent (the so-called sensitivity test in vivo) and therefore in assessing real activity of the antimicrobial under evaluation. Moreover, the performance of myringotomy during AOM is unquestionable whenever in the presence of a potential or overt risk of complication.11 The Rat as Model in Acute Otitis Media Histopathological study of the dynamics of healing in the tympanic membrane (TM) after myringotomy is not feasible in humans, due to ethical reasons. For years, the experimental induction of AOM for histopathological study has been preferentially developed through the inoculation of the middle ear with diverse types of viable bacteria in various animal species such as the chinchilla12-15, Mongolian gerbil16, the cat17, and the rat.18-30 Amongst these different animal models, the Sprague-Dawley rat has been one of the most consistently used and tested, in which viable bacteria is inoculated in the bulla of the middle ear via an incision in the ventral skin of the neck.18-20,22-24,26,28,29,31-35 Moreover, morphological similarities of the TM in rat and human36 favor its experimental use and allow consistent extrapolations towards possible applications of clinical interest. Since this is so, various researchers have used the TM of rats as a model for study of healing in the TM, either spontaneous healing23,37-39 or healing following topical application of substances such as exogenous heparin40, cortico-steroids41, hyaluronan42, diverse growth factors43-45, and stem-cells.46 The following discussion pertains to two experimental studies using the SpragueMyringotomy in Acute Otitis Media: Experimental Aspects