By Yolanda Smith, BPharm
Approximately half of all cases of ear pain reported by children resolve in three days without treatments and 90% within a week. As a result, treatment is not always needed and may simply be used to manage symptoms whilst the body heals itself.
For acute otitis media, the pain can be quite severe and treatment to address this is important. The most common medications used are oral paracetamol, ibuprofen or opioids, as well as antipyrine and benzocaine eardrops.
Paracetamol is usually preferred as it is associated with fewer side effects, with ibuprofen being a suitable alternative.
Decongestants and antihistamines have not been shown to offer a large benefit and there is some concerns regarding possible side effects. As a result, these formulations – both intranasal and oral – are not recommended for use in the treatment of this condition.
Antibiotics may be useful in helping to shorten recovery time of acute otitis media, but are also associated with side effects so the benefits must be weighed up against the risks.
The vast majority of acute episodes settle without the need for treatment, so routinely treating children with symptoms of otitis media will result in a large number of unneeded treatments. These treatments may also cause harm, such as vomiting, diarrhea or rash as side effects.
As a general rule, antibiotics are indicated for those with severe symptoms or for those less than two years old. Additionally, even if the symptoms are mild to moderate, if they do not improve within 2 to 3 days antibiotics may offer a benefit.
The first line choice of antibiotic is usually amoxicillin. However, alternative treatment options may be indicated in some circumstances. For example, if there is suspected resistance to amoxicillin or if the child has used it in the preceding 30 days, an alternative choice may be beneficial.
The second line choice is amoxicillin-clavulanate or another penicillin derivative in conjunction with a beta lactamase inhibitor. If treatment is taken for more than 48 hours without a noticeable improvement in symptoms being evident, it is advisable to change antibiotic therapy.
The typical treatment length is longer than 7 days. This carries a slightly greater risk of side effects but is more effective, particularly to prevent infection recurrence.
Topical quinolone antibiotics are another option that appear to be more effective for the discharge associated with chronic suppurative otitis media, however the safety profile of this has not been determined.
Some individuals tend to get recurrent infections and may benefit from methods to prevent the infection from returning to their ears.
Tympanostomy tubes, also known as a grommet, are one method that may help to decrease the recurrence of infection. People who have at least 3 episodes of acute otitis media within 6 months, or more than 4 in a year, may benefit from tympanostomy tubes.
The tube is inserted into the eardrum and helps to reduce the recurrence rates for the proceeding 6 months. The side effect profile is good and there is little effect on long-term hearing, however some people may experience a discharge from the ear known as otorrhea.
In the case of discharge from the ears as a result of the tubes, topical antibiotic eardrops are the treatment of choice to manage this, rather than oral antibiotics. This is because oral antibiotics are less effective and also increase the risk of opportunistic infections.
The alternative treatments for otitis media have not been studied greatly and, as a result, there is limited evidence to recommend or caution against their use.
Galbreath technique is a type of osteopathic manipulation technique that has shown some efficacy and may be a promising treatment, although the evidence to date is inconclusive.
Last Updated: Apr 9, 2015