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Topical analgesia for acute otitis media
R Foxlee1, A Johansson, J Wejfalk
1Faculty of Health Sciences and Medicine, Cochrane Acute Respirartory Infections Group, Bond University, Gold Coast, Queensland, Australia 4229. rfoxlee@staff.bond.edu.au
Background:
Acute 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.
Objectives:
To assess the effectiveness of topical analgesia for AOM.
Search Strategy:
We 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 Criteria:
Double-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 Analysis:
Potential 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 Results:
Our 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.
Authors' Conclusions:
The evidence from these four randomised controlled trials, only one of which addresses the most relevant question of primary effectiveness, is insufficient to know whether ear drops are effective or not.
Insights
Topical analgesia for acute otitis media (AOM) shows limited evidence of effectiveness. One study indicated a 25% pain reduction with anesthetic drops, but overall data is insufficient to confirm efficacy.
Area of Science:
- Otolaryngology
- Pain Management
- Evidence-Based Medicine
Background:
- Acute otitis media (AOM) is a common childhood illness characterized by significant pain.
- Antibiotic efficacy for AOM is increasingly questioned, prompting research into alternative treatments.
- Topical analgesia offers a potential non-systemic approach to managing AOM-related pain.
Purpose of the Study:
- To evaluate the effectiveness of topical analgesic ear drops for pain relief in acute otitis media.
- To synthesize findings from randomized controlled trials comparing analgesic ear drops with placebo or other treatments.
Main Methods:
- A systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS) was conducted.
- Inclusion criteria focused on double-blind randomized controlled trials of otic preparations with analgesic effects (excluding antibiotics) in AOM patients without perforation.
- Data extraction and quality assessment were performed independently by multiple authors.
Main Results:
- Four trials met the inclusion criteria, involving a total of 328 participants.
- One trial showed a 25% pain reduction with anesthetic ear drops compared to placebo at 30 minutes.
- Three trials comparing anesthetic drops with naturopathic herbal drops favored the herbal preparation in pain reduction.
Conclusions:
- The current evidence from four randomized controlled trials is insufficient to determine the effectiveness of topical analgesic ear drops for AOM.
- Further high-quality research is needed, particularly addressing the primary effectiveness of analgesic preparations.
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