ear, nose, and throat disorders
Otitis Media (Acute)
Treatment of Acute Otitis Media
Analgesics Sometimes antibiotics Rarely myringotomy Analgesia should be provided when necessary, including to preverbal children with behavioral manifestations of pain (eg, tugging or rubbing the ear, excessive crying, fussiness). Oral analgesics, such asacetaminophenoribuprofen, are usually effective; weight-based doses are used for children. A variety of topical agents are available by prescription and over the counter. Although not well-studied, some topical agents may provide transient relief but probably not for more than 20 to 30 minutes. Topical agents should not be used when the tympanic membrane is perforated. Most (80%) cases resolve spontaneously; however, in the United States, antibiotics are often given ([ Treatment reference ]; see table Those who are younger or more severely ill—see table) Those with recurrent acute otitis media (eg,≥4 episodes in 6 months) Others, provided there is good follow-up, can safely be observed for 48 to 72 hours and given antibiotics only if no improvement is seen; if follow-up by phone is planned, a prescription can be given at the initial visit to save time and expense. Decision to observe should be discussed with the caregiver. All patients are given analgesics (eg,acetaminophen,ibuprofen). In adults, topical intranasal vasoconstrictors, such asphenylephrineoroxymetazoline, may improve eustachian tube function, although the efficacy of these preparations has not been clearly shown. To avoid rebound congestion, these preparations should not be used>3 days. Systemic decongestants (eg,pseudoephedrine30 to 60 mg orally every 6 hours as needed) may help relieve sinonasal congestion or pressure. Antihistamines (eg,chlorpheniramine4 mg orally every 4 to 6 hours for 7 to 10 days) may improve eustachian tube function in people with allergies but should be reserved for the truly allergic. For children, neither vasoconstrictors nor antihistamines are of benefit. Myringotomy may be done by a specialist for a bulging tympanic membrane, particularly if severe or persistent pain, fever, vomiting, or diarrhea is present. Tympanometry is used to monitor tympanic membrane movement; the patient's hearing and tympanic membrane appearance and movement are monitored until normal. If facial nerve palsy or weakness occurs in patients with acute otitis media, patients must be urgently referred to a specialist for possible myringotomy and placement of a tympanostomy tube. 1.Lieberthal AS, Carroll AE, Chonmaitree T, et al: The diagnosis and management of acute otitis media.Pediatricse964–99, 2013. 