Topical analgesia for acute otitis media

Abstract

BackgroundAcute otitis media (AOM) is a spontaneously remitting disease for which pain is the most distressing symptom. Antibiotics are now known to have less benefit than previously assumed. ObjectivesTo assess the effectiveness of topical analgesia for AOM. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May Week 3 2006, EMBASE (1990 to December 2005 and LILACS (1982 to September 2005) without language restriction, and the reference lists of articles. We also contacted manufacturers and authors. Selection criteriaDouble-blind randomised or quasi-randomised controlled trials comparing an otic preparation with an analgesic effect (excluding antibiotics) versus placebo or an otic preparation with an analgesic effect (excluding antibiotics) versus any other otic preparation with an analgesic effect, in adults or children presenting at primary care settings with AOM without perforation. Data collection and analysisPotential studies were screened independently and trial quality was assessed by three authors, and differences were resolved by discussion. Data was then independently extracted from the trials selected by two authors. We contacted the authors of three trials to acquire additional information not available in published articles. Main resultsOur searches yielded 356 records; four trials met our criteria. One trial with 54 participants compared treatment with anaesthetic ear drops versus an olive oil placebo immediately at diagnosis. All patients were also given paracetamol. There was a statistically significant pain reduction of 25% in those receiving anaesthetic drops 30 minutes after instillation. Three trials (with one common co-author) compared anaesthetic ear drops with naturopathic herbal ear drops in 274 patients. One of these trials also used antibiotics in both groups. There were statistically significant differences at instillation of drops, or 15 or 30 minutes after the instillation (or both) on one to three days after diagnosis, always favouring the naturopathic group in each trial.

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

“…After 30 minutes, the majority of children in our study reported minimal (pain score < = 2) or no ear pain regardless of which ear drops were used (lignocaine 81%, placebo 59%). This rapid improvement regardless of intervention is consistent with findings in other studies of topical analgesic ear drops6 7 21 22 and has been interpreted as possibly owing to the natural course of the illness, the placebo effect of being in a clinical setting or the soothing effect of any liquid on the inflamed TM 6. An interpretation of our results is the adjunctive effect of simple oral analgesia that reduces acute ear pain associated with AOM.…”

“…A Cochrane review published in 2006 has attempted to address this issue 6. The authors concluded that of the four studies that had been conducted, only Hoberman and colleagues’ study7 addressed the question of efficacy of topical agents for ear pain of otitis media, and that the data were insufficient to reach a conclusion.…”

Does Bradford's Law of Scattering predict the size of the literature in Cochrane Reviews?

“…The search in the Cochrane Library on the subject acute otitis media found 22 Cochrane Reviews, 5 of which met inclusion criteria [15][16][17][18][19], yielding 135 articles from 73 journals. For pneumonia, the search in the Cochrane Library found 62 reviews, of which 9 met the inclusion criteria, yielding 251 articles from 110 journals [20][21][22][23][24][25][26][27][28].…”

Contemporary Concepts in Management of Acute Otitis Media in Children

“…7,31,38 Although there are many options for treatment of otalgia, including oral, topical, and homeopathic agents, few have been well studied. 7,39 …”