Abstract
Although many studies have investigated the expression and role of nitric oxide (NO) in various diseases, it remains unclear whether NO has a beneficial or detrimental impact on otitis media. This review examines the literature on the expression and role of NO in different forms of otitis media, including acute otitis media, otitis media with effusion, chronic otitis media, and cholesteatomatous otitis media. Of the 22 studies reviewed, 18 reported that NO induces or exacerbates otitis media, whereas two studies suggested that NO may aid in its treatment. Factors contributing to these conflicting results include the type of otitis media studied, the duration of the condition, the types of samples collected, and the specific type of NO synthase targeted. Comprehensive analysis indicates that NO expression may be higher in chronic otitis media than in acute forms and is more pronounced in patients with cholesteatoma than in those without it. Although these findings suggest that NO inhibitors could potentially aid in the treatment of otitis media, NO could also aid in its treatment by inhibiting bacterial infections. Despite the dual potential of NO, current evidence suggests a strong association between NO and the pathophysiology of otitis media.