Otitis media and externa

Summary

Given the frequency of otitis media (OM) and otitis externa (OE), there is surprisingly little evidence on treating pain associated with these conditions. For both conditions, there can be utility in mechanical interventions. The NSAIDs are typically recommended as first-line treatment, although evidence is sparse. Topically applied local anesthetics, generally benzocaine, are widely used for otalgia. A eutectic mixture of local anesthetics (EMLA), which contains lidocaine and prilocaine, is described as effective for relieving OE pain. Naturopathic topical approaches for OM are found by one investigator to be effective than the topical local anesthetic amethocaine. Trial evidence and reviews find neither antihistamines nor corticosteroids are effective in reducing OM pain. There are no data assessing otalgia relief for systemically administered opioids. However, expert panel evidence supports use of oral agents such as oxycodone or hydrocodone (usually in combination with acetaminophen or ibuprofen) for severe otalgia from either OM or OE.