Topical Anaesthesia of the Normal Tympanic Membrane: A Controlled Clinical Trial of Different Suspensions of Lidocaine

Møller, Ågot; Grøntved, Ågot Møller

doi:10.1159/000276128

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…Yang et al [73] have investigated the efficacy of buvicaine and tetrodotoxin in a hydrogel in animal studies and demonstrated penetration of buvicaine -a local anesthetic -through the tympanic membrane into the middle ear. Whether the tympanic membrane is inflamed or normal seems to play a role in the penetration ability of the agent used [31] and in which pharmaceutical preparation the administered local anesthetic is present.…”

Section: Discussionmentioning

confidence: 99%

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Pain Relief by Analgesic Eardrops: Paradigm Shift in the Treatment of Acute Otitis Media?

Michel

2021

Drug Res (Stuttg)

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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.

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Section: Discussionmentioning

confidence: 99%

“…The pH plays an important role in this process, since all local anesthetics are weak electrolytes and their dissociation is influenced by the pH [31]. A low pH value, which occurs for example during inflammation, reduces the diffusion of local anesthetics [29].…”

Section: Pain Sensationmentioning

confidence: 99%

Pain Relief by Analgesic Eardrops: Paradigm Shift in the Treatment of Acute Otitis Media?

Michel

2021

Drug Res (Stuttg)

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“…Although aqueous lignocaine has previously been shown to be ineffective on un-inflamed squamous epithelium, including the external TM,19 the fact that an altered epithelium in other settings, such as napkin rash8 and under occlusive dressings,20 has demonstrated increased uptake of the drug may give good reason to explain the greater effectiveness to the TM when it is inflamed.…”

Section: Discussionmentioning

confidence: 99%

Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial

Bolt

Barnett

Babl

et al. 2008

Archives of Disease in Childhood

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Objective: Acute otitis media (AOM) is common in children, yet the optimal management of ear pain associated with AOM has not been well studied. We set out to determine the efficacy of topical aqueous 2% lignocaine eardrops compared with a placebo (saline) for pain relief of AOM in children. Design: Double-blind, randomised, placebo-controlled trial. Setting: Tertiary children's hospital emergency department. Patients and interventions: Children aged between 3 and 17 years with earache and AOM without evidence of perforation were eligible. Patients were randomised to receive either 2% lignocaine or saline eardrops (placebo). Main outcome measures: Pain scores were measured before and after ear-drop administration. Patient and physician-interpreted pain scores were measured by using the Bieri faces pain scale and visual analogue scale at 10, 20 and 30 minutes. The primary outcome measure was reduction in patient-measured pain scores by 50% from the baseline. Secondary outcome measures were reduction in patient-measured pain scores by 25% or by at least two points. Telephone follow-up occurred after 1 day and 1 week. Analysis was by intention to treat. Results: 63 children (31 were treated with lignocaine, 32 with placebo) aged 3 to 12 years were enrolled. The groups were demographically and clinically similar, with similar proportions having received analgesia in the preceding 4 hours. Children receiving lignocaine showed significantly lower patient-measured pain scores with a reduction by 50% from baseline at 10 minutes (RR 2.06, 95% CI 1.03-4.11, p = 0.03) and 30 minutes (RR 1.44, 95% CI 1.07-1.93, p = 0.009) but not at 20 minutes (RR 1.35 95% CI 0.88-2.06). The response to lignocaine treatment showed significantly lower patient-measured pain scores for 25% reduction at all time points and for two-point reduction at 10 minutes and favoured lignocaine at 20 minutes and 30 minutes without reaching statistical significance. There were no serious adverse events during the 30 minute follow-up period. Conclusion: This study suggests that topical aqueous 2% lignocaine eardrops provide rapid relief for many young children presenting with ear pain attributed to AOM. The concurrent use of simple oral analgesia is a likely contributor to effective management of this painful childhood condition.

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Topical Anaesthesia of the Normal Tympanic Membrane: A Controlled Clinical Trial of Different Suspensions of Lidocaine

Cited by 2 publications

References 11 publications

Pain Relief by Analgesic Eardrops: Paradigm Shift in the Treatment of Acute Otitis Media?

Pain Relief by Analgesic Eardrops: Paradigm Shift in the Treatment of Acute Otitis Media?

Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial

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