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Otalgia Medication

  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Sep 18, 2015
 

Medication Summary

Use antibiotics in treating various types of infections (eg, tonsillitis, pharyngitis, sinusitis). Use antivirals if the causative agent is suspected to be viral such as in cases associated with herpes zoster or shingles. Antifungals are indicated if the source is caused by a fungus (eg, oral thrush/candidiasis). Antiulcer/antacid medications can be used for esophagitis or gastroesophageal reflux disease. Use NSAIDs when myalgias and neuralgias are suspected. Reexamine the patient after a 2-week trial of NSAIDs.

Perform a detailed search for the underlying diagnosis before initiating treatment. Starting analgesics before reaching a diagnosis increases the difficulty of determining the cause and may possibly obscure a life-threatening condition such as an occult cancer.

Any of the previously mentioned treatments can be implemented when the exact cause of referred otalgia is suspected. If the problem persists after a 2- to 3-week trial, a more advanced algorithm is indicated.

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Antibiotics

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting. Resort to empiric antimicrobial therapy only after an exhaustive search for a source of pain has failed.

Amoxicillin and clavulanate (Augmentin)

 

Treats bacteria resistant to beta-lactam antibiotics.

Amoxicillin (Amoxil, Trimox)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Clarithromycin (Biaxin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing cessation of RNA-dependent protein synthesis.

Ciprofloxacin (Cipro)

 

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis, and consequently, growth.

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Antivirals

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate.

Acyclovir (Zovirax)

 

Has demonstrated inhibitory activity against both HSV-1 and HSV-2. Selectively incorporated into infected cells.

Famciclovir (Famvir)

 

Prodrug that when biotransformed into active metabolite, penciclovir, may inhibit viral DNA synthesis/replication.

Valacyclovir (Valtrex)

 

Prodrug rapidly converted to the active drug acyclovir. More expensive but has a more convenient dosing regimen than acyclovir.

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Antifungals

Class Summary

Mechanism of action may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.

Fluconazole (Diflucan)

 

Synthetic PO antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation.

Nystatin (Mycostatin)

 

Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei. Effective against various yeasts and yeastlike fungi. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak.

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Antacids

Class Summary

These agents can be used for esophagitis or gastroesophageal reflux disease.

Famotidine (Pepcid)

 

Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and reduced hydrogen concentrations.

Ranitidine (Zantac)

 

Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which reduces gastric acid secretion, gastric volume, and hydrogen concentrations.

Lansoprazole (Prevacid)

 

Inhibits gastric acid secretion.

Omeprazole (Prilosec)

 

Inhibit gastric acid secretion by inhibiting H+/K+ ATPase enzyme system at secretory surface of gastric parietal cells.

Esomeprazole magnesium (Nexium)

 

S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells.

Used in severe cases of and patients not responding to H2 antagonist therapy.

Used for up to 4 wk to treat and relieve symptoms of active duodenal ulcers; may be used up to 8 wk to treat all grades of erosive esophagitis.

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Analgesics

Class Summary

Pain control is essential to quality patient care.

Ibuprofen (Motrin, Advil)

 

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Hydrocodone and acetaminophen (Lortab, Vicodin)

 

Drug combinations indicated for moderate to severe pain.

Oxycodone and acetaminophen (Percocet)

 

Drug combination indicated for the relief of moderate to severe pain.

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Contributor Information and Disclosures
Author

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, American College of Surgeons, American Medical Association, American Tinnitus Association, Florida Medical Association, North American Skull Base Society

Disclosure: Received consulting fee from Synthes Power Tools for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Auditory Society, The Triological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Neurotology Society, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Michael E Hoffer, MD Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Received royalty from American biloogical group for other.

Acknowledgements

Jared Brunk, PA-C Physician Assistant Certified, Office of John Li, MD

Disclosure: Nothing to disclose.

Thomas Ulrich, PA-C Physician Assistant Certified, Office of John Li, MD

Disclosure: Nothing to disclose.

References
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  7. Gibson WS Jr, Cochran W. Otalgia in infants and children--a manifestation of gastroesophageal reflux. Int J Pediatr Otorhinolaryngol. 1994. Jan;28(2-3):213-8.

  8. Kuttila S, Kuttila M, Le Bell Y. Characteristics of subjects with secondary otalgia. J Orofac Pain. 2004 Summer. 18(3):226-34.

  9. Scarbrough TJ, Day TA, Williams TE. Referred otalgia in head and neck cancer: a unifying schema. Am J Clin Oncol. 2003. Oct;26(5):e157-62.

  10. Shah RK, Blevins NH. Otalgia. Otolaryngol Clin North Am. 2003 Dec. 36(6):1137-51. [Medline].

  11. Subramaniam S, Majid MD. Eagle's syndrome. Med J Malaysia. 2003 Mar. 58(1):139-41. [Medline].

  12. Travell JG, Simons DG. Myofascial pain and dysfunction. The Trigger Point Manual. Baltimore, Md: Lippincott Williams & Wilkins; 1983.

 
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This picture demonstrates the diversity of pathologies that can be the source of referred otalgia.
 
 
 
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