Evaluation of Pain Management in Acute Otologic Conditions by Otolaryngologists: A Case-Control Study

This study aimed to evaluate pain management strategies implemented by otolaryngologists for acute infectious otologic conditions including Acute Otitis Externa (AOE), Acute Otitis Media (AOM) and Bullous Myringitis (BM). The primary objective was to evaluate pain assessment and treatment across these groups. Secondary objectives analyzed repeat visit rates and their association with incident pain, demographic and clinical characteristics.

A retrospective case-control study of 478 patients presenting to the ED between 01/2022 and 01/2023. Otologic cases were evaluated in the otolaryngology ED and included AOE (n = 316) and AOM / BM (n = 95). Controls consisted of patients with conservatively treated ureterolithiasis (n = 67). Data included demographic and clinical variables, along with a structured evaluation of pain documentation, treatment, and discharge plans. For high-scoring discharge plans, the specifics of prescribed medications were analyzed.

Otologic patients had a mean visual analog scale (VAS) score of 5.0, compared to ureterolithiasis 6.7. Otologic pain management was less comprehensive, with ED treatment administered to 12% to 13%, compared to 72.6% of ureterolithiasis patients (P < .001). Similarly, only 6% to 14.8% of otologic patients received comprehensive analgesic discharge plans, compared to 71.2% in the ureterolithiasis cohort (P < .001). Opioid-based monotherapy was the primary treatment modality in the otologic groups (86%-90%) compare to more diverse and synergistic, NSAID based regimens in the ureterolithiasis cohort. No differences in ED revisits were observed. Age, sex, ethnicity, and comorbidities did not significantly correlate with pain levels or outcomes.

This study reveals shortcomings in pain management in acute otologic conditions. Given the reported inadequacies in pain management training among Otolaryngology trainees, and continued neglect of pain recommendations proposed by specialty- specific clinical practice guidelines, there is an urgent need for analgesic awareness and standardized protocols to ensure consistent and effective care in these everyday conditions.