Otalgia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S[2]
Overview
Treatment of Otalgia lies in identifying the pathology, whether it exists within the ear or elsewhere.
- Antibiotics are used to treat infectious causes like Otitis media, Otitis externa, tonsillitis, Pharyngitis etc.,
- Antivirals can be used for viral causes like herpes zoster oticus.
- Antifungals for Oral thrush.
- NSAIDs if myalgias and neuralgias are suspected. Re-examine the patient after 2 weeks trial of NSAIDs.
Appropriate consultation with a neurologist, dentist, gastroenterologist etc., should be done.
Medical management of Otalgia caused by ear causes
- Antibiotics are the mainstay of treatment of uncomplicated acute otitis media (AOM) in adults. The preferred antibacterial drug for the patient with AOM must be active against Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. Amoxicillin remains the drug of choice for initial therapy of AOM.
- Mild to moderate disease: 500 mg every 12 hours, or 250 mg every 8 hours for 5 - 7 days.
- Severe disease: 875 mg every 12 hours, or 500 mg every 8 hours for 10 days.
Alternatives to amoxicillin in case of penicillin allergy:
- Cefdinir (300 mg twice a day or 600 mg once daily)
- Cefpodoxime (200 mg twice a day)
- Cefuroxime (500 mg every 12 hours)
- Ceftriaxone (2 g IM or IV once)
Treatment
- Warm compress
- Physical therapy, dental bite adjustment (TMJ)
- Remove foreign bodies with a curette
Pharmacotherapy
Acute Pharmacotherapies
- Control pain with acetaminophen, nonsteriodal anti-inflammatory drugs (NSAIDs), and topical benzocaine solution
- Antibiotics (otitis media, otitis externa, pharyngitis / tonsillitis)
- NSAIDs for TMJ
- Steroid drops, 8% aluminum acetate +/- 2% acetic acid (otitis externa)
- Antistaphylococcal antibiotics, IV antipseudomonal (malignant otitis externa)
- Decongestants (barotrauma)