Otalgia medical therapy
|
Otalgia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Otalgia medical therapy On the Web |
|
American Roentgen Ray Society Images of Otalgia medical therapy |
|
Risk calculators and risk factors for Otalgia medical therapy |
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 include 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 of Otitis externa includes
- Pain management using NSAIDs.
- Gently cleansing the debris from the external auditory canal with irrigation or by using a soft plastic curette or cotton swab under direct visualization.
- Topical medical therapy which includes a combination of mild acid, corticosteroids and either an antibiotic or antifungal. Mild disease can be treated by using an acidifying agent and a corticosteroid. As an alternative a 2:1 mixture of 70% isopropyl alcohol and acetic acid can be used. More severe disease requires addition of an antibacterial or antifungal to the above.
- Oral antibiotics are generally preferred in patients with fevers, immunosuppression, diabetes, adenopathy, or in those individuals with extension of the infection outside of the ear canal.
- Chronic, noninfectious, therapy-resistant external otitis can be treated using 0.1% Tacrolimus cream according to a prospective study by Caffier et al.
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)