Use of Ototopical Antibiotics in Treating 3 Common Ear Diseases

Hannley, Maureen; Denneny, James C.; Holzer, Susan Sedory

doi:10.1067/mhn.2000.107813

Cited by 98 publications

(72 citation statements)

References 16 publications

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“…They have not found evidence that systemic antibiotics alone improved treatment outcome. 21 If antibiotics do not change the natural course of otitis media, then the main goal of treatment, as in the present study, should be to alleviate the ear pain. The alternative, naturopathic herbal extract medications, may offer many new possibilities in the management of ear pain associated with AOM.…”

Section: Discussionmentioning

confidence: 99%

Naturopathic Treatment for Ear Pain in Children

2003

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ABSTRACT.Objective. Otitis media is 1 of the most frequent diseases of early infancy and childhood and 1 of the most common reasons for children to visit a physician. In the past 2 decades, there has been a substantial increase in the diagnosis of otitis media worldwide. In the United States, 93% of all children have had at least 1 episode of acute otitis media (AOM) by 7 years of age. Otalgia is the hallmark of AOM. Most affected children either complain of earache or manifest behavior that the parents interpret as indicating ear pain. Treatment of the ear pain early in the course of AOM decreases both parental anxiety and the child's discomfort and accelerates the healing process. The objective of this study was to determine the efficacy and tolerability of naturopathic versus traditional treatment for the management of otalgia commonly associated with AOM in children.Methods. The study was designed as a double-blind trial in an outpatient community clinic. A total of 171 children who were aged 5 to 18 years and had otalgia and clinical findings associated with middle-ear infection were studied. The children were randomly assigned to receive treatment with Naturopathic Herbal Extract Ear Drops (NHED) or anesthetic ear drops, with or without amoxicillin. On enrollment, the children were assigned by computer-numbered randomization to receive NHED (contents: allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil) 5 drops 3 times daily, alone (group A) or together with a topical anesthetic (amethocaine and phenazone in glycerin) 5 drops 3 times daily (group B), or oral amoxicillin 80 mg/kg/d (maximum 500 mg/dose) divided into 3 doses with either NHED 5 drops 3 times daily (group C) or topical anesthetic 5 drops 3 times daily (group D). A double-blind design was used, and all ear drops were placed in identical bottles. Treatment was initiated by the nurse in all cases. A single physician (M.S.) evaluated and treated all of the patients included in the study and recorded all of the data. The presence or absence of ear pain was assessed over 3 days with a visual analog scale. Ear pain was assessed by a specially devised observational instrument based on previous reports. One side of the instrument consisted of a linear numbered scale, from 1 (no pain) to 10 (worst possible pain), and a corresponding color scale, ranging from blue to dark red. The reverse side contained a scale of 5 facial expressions, ranging from broad smile (no pain) to a sad and crying face (worst possible pain), and a corresponding color scale, ranging from blue to dark red.Results. There were no significant between-group differences in patient age or gender, degree of fever, main symptoms, associated symptoms, and severity or laterality of acute otitis media. Each group had a statistically significant improvement in ear pain over the course of the 3 days. Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin. Results...

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Section: Discussionmentioning

confidence: 99%

Naturopathic Treatment for Ear Pain in Children

2003

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“…5,11 Approximately 50% of bacterial cases involve Pseudomonas aeruginosa, followed in incidence by Staphylococcus aureus, and then various aerobic and anaerobic bacteria. 3,6,12,13 The incidence of fungal infection is only 10%. Less than five per cent of acute disease cases can be attributed to furunculosis (usually staphylococcal), S Afr Fam Pract 2011 herpes zoster oticus, or non-specific conditions, e.g.…”

Section: Pathophysiologymentioning

confidence: 99%

“…It affects 3-5% of the population. [1][2][3][4] Acute OE is unilateral in 90% of patients; it peaks in persons seven to 12 years of age, declines after 50 years of age, and often, is associated with high humidity, warmer temperatures, swimming, local trauma, and hearing aid or hearing protector use. 5 Manifestations include pruritus, pain, and erythema, but as the disease progresses, other problems such as oedema, otorrhoea, and conductive hearing loss may develop.…”

Section: Introductionmentioning

confidence: 99%

Otitis externa: review and clinical update

Osguthorpe

2011

South African Family Practice

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Otitis externa can take an acute or a chronic form, with the acute form affecting four in 1 000 persons annually and the chronic form affecting 3-5% of the population. Acute disease commonly results from bacterial (90% of cases) or fungal (10% of cases) overgrowth in an ear canal subjected to excess moisture, or to local trauma. Chronic disease often is part of a more generalised dermatologic or allergic problem. Symptoms of early acute and most chronic disease include pruritus and local discomfort. If left untreated, acute disease can be followed by canal oedema, discharge, and pain, and eventually by extra-canal manifestations. Topical application of an acidifying solution is usually adequate in treating early disease. An antimicrobial containing ototopical is the preferred treatment for later-stage acute disease, and oral antibiotic therapy is reserved for advanced disease or those who are immunocompromised. Preventative measures reduce recurrences, and typically involve minimising ear canal moisture, trauma, or exposure to materials that incite local irritation or contact dermatitis.

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“…Because topical therapy is efficacious, systemic antibiotics are often prescribed inappropriately. 15,40 When topical therapy is prescribed, confusion exists about whether to use an antiseptic (eg, acetic acid), antibiotic, corticosteroid, or a combination product. Antibiotic choice is controversial, particularly regarding the role of newer quinolone drops.…”

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confidence: 99%

Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

120

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Objective. This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE.Purpose. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed.Action Statements. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. Keyw...

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Use of Ototopical Antibiotics in Treating 3 Common Ear Diseases

Cited by 98 publications

References 16 publications

Naturopathic Treatment for Ear Pain in Children

Naturopathic Treatment for Ear Pain in Children

Otitis externa: review and clinical update

Clinical Practice Guideline: Acute Otitis Externa

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