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Three Part Question

In [acute otitis media] is [the use of topical analgesia better than placebo] at [reducing pain and discomfort]?

Clinical Scenario

A 6 year-old boy presents to the emergency department with a two day history of earache and fever. After examination, Acute Otitis Media was diagnosed and a prescription for analgesia and oral antibiotic course were given. You wonder if the administration of topical analgesia (ie eardrops) would be helpful in providing additional and fast relief of this child's pain symptoms.

Search Strategy

Medline. 1950 to week 2 2007 on the OVID interface.
[exp otitis media] and [exp Anesthetics, Local/or local anaesthetics.mp] limit to human, english language and abstracts

Search Outcome

Ten papers were found using the reported search. Of these one recent review article was found that incorporated all previous trials. A further recent paper was found via the Emergency Department Journal Club shortly before publication of this report.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Foxlee R et al, 2006, Australia	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	Meta-Analysis / Review.	No of relevant trialsComparison with olive oilComparison with naturopathic ear drops	4 were identified1 Trial comparing topical anaesthesia to olive oil found a 25% reduction in pain at 30 min3 Trials, all showed benefit to the naturopathic treatments	Little evidence from small numbers of patients2 of the naturopathic trials were conducted by the same author
Bolt et al, 2008, Australia	Children aged 3–12 presenting to paediatric ED with earache and clinical diagnosis of AOM randomised to 2% lignocaine or saline ear drops	Prospective randomised controlled trial	Reduction in pain score by 50%	Statistically significant reduction in pain score at 10 and 30 min for lignocaine drops vs saline but not at 20 min	Not adjusted for administration of oral analgesia Placebo (saline) effective at 30 min for 59% of children

Comment(s)

Topical analgesics, in the form of eardrops, may have benefit in the treatment of acute otitis media. Their application is for symptomatic relief. There was no evidence in the review that the application of the drops resulted in an alteration to the course of the disease.

Editor Comment

AOM, acute otitis media.

Clinical Bottom Line

Topical analgesics may have a short-term analgesic effect in otitis media but there is insufficient evidence to recommend that they are used instead of oral analgesics.

References

1. Foxlee R, Johansson A, Wejfalk J et al. Topical analgesia for acute otitis media. Cochrane Database Syst Rev. 2006;3:CD005657.
2. Bolt P, Barnett P, Babl FE, et al. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child 2008; 93: 40–44.