Elsevier

American Journal of Otolaryngology

Volume 32, Issue 1, January–February 2011, Pages 28-31
American Journal of Otolaryngology

Original contribution
Comparison between topical honey and mafenide acetate in treatment of auricular burn

https://doi.org/10.1016/j.amjoto.2009.07.005Get rights and content

Abstract

The auricle is a frequently injured part of the head and neck during thermal injury leading to ear deformity. The burned ear represents one of the most difficult problems for reconstructive surgeons. Mafenide acetate is a topical agent used routinely for these patients, but it has some disadvantages including painful application and allergic rash. Some authors have reported the healing effect and antibacterial activity of honey. The study reported here was undertaken to compare the effect of honey and mafenide acetate on auricular burn in rabbit. In our study, although the pathologic score of the honey group was better than that of the mafenide group both on 14 and 21 days after burning, it was not statistically significant. In the mafenide acetate group, deep complication of burn (chondritis) was significantly lower than that of the honey group. In conclusion, in contrast to healing and antibiotic activity reported for honey, it may have failure in preventing deep bacterial complications of wound (like chondritis). So in deep wounds, the use of honey as dressing is not recommended.

Introduction

The auricle is a frequently injured part of the head and neck during thermal injury leading to ear deformity. The burned ear represents one of the most difficult problems for reconstructive surgeons because of the dense scarred tissue that usually surrounds it [1]. From an anatomical point of view, the ear has no subcutaneous tissue to protect the cartilaginous framework. This cartilaginous framework, once exposed or injured, is particularly susceptible to infection [2].

Auricular deformities can be a result of both direct thermal injuries and subsequent chondritis, which is a severe complication of ear burns that can even destroy the unburned cartilage if not recognized early [3]. Auricular chondritis secondary to bacterial invasion of the cartilage is prevented by the routine use of topical mafenide acetate on all burned ears [4].

Mafenide acetate is a topical agent with a broad spectrum of activity because of its sulfa moiety. It is particularly useful against resistant Pseudomonas and Enterococcus species. It can also penetrate eschar. Its disadvantages include painful application on the skin, for example, in second-degree wounds. It can also cause an allergic rash, and it has carbonic anhydrase inhibitory characteristics that can result in metabolic acidosis when applied over large surfaces. For these reasons, mafenide acetate is typically reserved for small full-thickness injuries [5].

Honey has been used for medicinal purposes since ancient times. It was used topically in ayurvedic medicine during 2500 bc, and Egyptians, Greeks, and Romans used it as well. Hippocrates prescribed honey for various indications including the management of wounds and gastritis. In addition, the wound-healing properties of honey were mentioned in the Qur'an and the Bible [6].

It has been proposed that the healing effect of honey could be due to various physical and chemical properties. The high osmolarity and acidity of honey are among the physical characteristics that contribute to its antibacterial activity. Hydrogen peroxide, volatiles, organic acids, flavonoids, beeswax, nectar, pollen, and propolis are important chemical factors that provide antibacterial properties to honey [7].

The antibacterial activity of honey has been confirmed in numerous studies [6], [8], [9]. White et al has reported that the major antibacterial factor in honey is hydrogen peroxide, which is produced by glucose oxidase originating from hypopharyngeal glands of honey bees. In addition, there is catalase in honey, which originates from pollin. The level of hydrogen peroxide in a given honey is determined by relative levels of glucose oxidase and catalase [10].

Likewise, most phytochemical factors withstand dilution in wound fluids. Overall, honey has a restraining influence on the growth of most bacteria, including some methicillin-resistant Staphylococcus aureus strains. This makes honey attractive for the prevention and treatment of infections in chronic wounds [11], [12], as well as for the treatment of acute wounds. Unlike most conventional local chemotherapeutics, honey does not lead to the development of antibiotic-resistant bacteria, and it may be used continuously [6]. Rapid clearance of infections, rapid suppression of inflammation, minimization of scarring, and stimulation of angiogenesis as well as tissue granulation and epithelium growth were reported with using honey for dressing [7].

All these physical and chemical factors give honey unique properties as a wound dressing. This study was undertaken to compare the effect of honey and mafenide on auricular burn in rabbit.

Section snippets

Materials and methods

Experimental design and treatment of animals were approved by the Animal Care Committee of Shiraz University of medical sciences. Fifteen male white rabbits (3.4 ± 0.4 kg) were used for the evaluation of ear burn wounds. Ketamine (25 mg/kg) and xylazine (1 mg/kg) were injected intramuscularly into the rabbits to induce sedation before a heated iron stamp was applied on the back of the auricles. The heated stamp (in boiling water 95°C ± 2°C) was applied for 8 seconds to form a dermal burn wound

Results

Mean histologic scale on day 14 for the mafenide group was 5.6 (range, 4–7; SD, 1.34), and for the honey group, it was 6.4 (range, 5–8; SD, 1.14), not being statistically significant. Mean histologic scale on day 21 for the mafenide group was 5.2 (range, 4–7; SD, 1.13), and for the honey group, it was 5.5 (range, 4–7; SD, 1.43). These differences were not statistically significant.

Table 2 shows histologic items score 21 days after burning. Fig. 1 shows the frequency of mafenide and honey's

Discussion

The medicinal and antimicrobial properties of honey in relation to wound treatment has been recognized for approximately 4500 years, where for instance, Prince Hal was treated with rose honey by John Bradmore, a London surgeon [3]. Honey was subjected to laboratory and clinical investigations during the past few decades [6], [8], [13]. We aimed in this study to compare the topical effect of this traditional medicine with mafenide acetate in the auricular burn outcome.

Antibacterial activity is

Conclusion

In conclusion, this study demonstrated that honey might have a better healing effect and epithelialization of the superficial wound than some topical antibiotics like mafenide acetate, but it needs more in vivo studies.

In contrast to antibiotic activity reported for honey, it fails in preventing deep bacterial complications of wound (like chondritis). So, in deep wounds, the use of honey as dressing is not recommended.

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