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n Summary and recommendations
First line: NSAID (e.g. ibuprofen 600–800 q6–8 h, maximum 2400 mg/day)
Reasonable:
n acetaminophen 650–1000 mg PO QID (if pain is mild and NSAID
contraindicated)
n topical benzocaine (3–4 drops 20% solution q1–4 h, with insertion of
saturated cotton plug) if tympanic membrane is not perforated
Pregnancy:
n acetaminophen
n topical benzocaine (3–4 drops 20% solution q3–4 h, with insertion of
saturated cotton plug) if tympanic membrane is not perforated
Pediatric:
n NSAID (e.g. ibuprofen 10 mg/kg PO QID)
n topical benzocaine (3–4 drops 20% solution q3–4 h, with insertion of
saturated cotton plug) if tympanic membrane is not perforated
Special case:
n severe pain: opioid (e.g. oxycodone 5–10 mg PO q4–6h)
References
Otitis media and externa 337
1. American Academy of Pediatrics and American Academy of Family Physicians.
Diagnosis and management of acute otitis media. Pediatrics. 2004;113
(5):1451–1465.
2. Rosenfeld RM, Brown L, Cannon CR, et al. Clinical practice guideline: acute
otitis externa. Otolaryngol Head Neck Surg. 2006;134(4 Suppl):S4–23.
3. Bertin L, Pons G, d’Athis P, et al. A randomized, double-blind, multicentre
controlled trial of ibuprofen versus acetaminophen and placebo for symptoms
of acute otitis media in children. Fundam Clin Pharmacol. 1996;10
(4):387–392.
4. Abramovich S, O’Grady J, Fuller A, et al. Naproxen in otitis media with effusion.
J Laryngol Otol. 1986;100(3):263–266.