Acute otitis media is a common middle ear infection in children with the
predominant symptoms of hearing impairment and pain. If antibiotics are given,
they need time to have an effect on the inflammation, so the focus is on pain
control. For pain management local anesthetics have the advantage of lesser
systemic side effects but are still subject to scrutiny. In this review the
literature between 2000 and 2020 was systematically searched for investigating
studies and recommendation in guidelines against the background of the mode of
action. 11 clinical studies, 2 guidelines and 5 reports resp. reviews could be
identified. Contraindications and side effects were not found in these studies.
The analgesic ear drops showed in placebo-controlled studies a relatively short
duration of action when applied once but rapid onset of action. There is
evidence that analgesic ear drops could provide a first-line analgesia in otitis
media without systemic adverse effects such as gastrointestinal disturbance and
nausea and could support an antibiotic-saving wait-and-see attitude. The review
shows a change in attitude towards the recommendation to include local
anesthetics ear drops in otitis media but still there is a lack in treatment
protocols which go beyond a single administration. The results do not yet show a
significant paradigm shift. The reviews revealed indications that a more adapted
galenic preparation could give more effectiveness. Pharmaceutical research in
this field should be intensified to exploit the analgesic potential of local
anesthetic ear drops in acute otitis media.