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Middle Ear, Eustachian Tube, Inflammation/Infection Medication

  • Author: Robert B Meek, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Apr 20, 2015
 

Medication Summary

Antimicrobials are frequently chosen for the treatment of acute otitis media (AOM) and OME.

Topical nasal decongestants, oral decongestants, nasal steroids, and antihistamines can be used to treat ETD.

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Antimicrobials

Class Summary

These agents are used to eradicate middle ear bacteria and prevent mastoiditis in acute otitis media (AOM) and to help speed the resolution of inflammation and effusion in COME.

Amoxicillin (Trimox, Biomox)

 

DOC for first-line OM in patients not allergic to penicillin. Administered for a total of 7-10 d for AOM.

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)

 

Useful in penicillin-allergic patients. Administered q12h for 10d to treat OM. High incidence of resistance.

Amoxicillin/clavulanate (Augmentin)

 

Drug combination treats bacteria resistant to beta-lactam antibiotics. Useful in patients who have failed first-line treatment of OM.

Cefuroxime (Ceftin, Kefurox, Zinacef)

 

Second-line antimicrobial agent for OM. Also for non type I penicillin allergic patients

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Oral decongestants

Class Summary

These agents are used to decrease swelling of eustachian tube and sinus mucosa.

Pseudoephedrine (Actifed, Sudafed, Afrin)

 

Used in patients with ETD. Not helpful in OME.

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Nasal corticosteroids

Class Summary

These agents are used to decrease perieustachian tube inflammation.

Mometasone (Nasonex)

 

Nasal spray; may decrease number and activity of inflammatory cells, resulting in decreased nasal inflammation. Demonstrated no mineralocorticoid, androgenic, antiandrogenic, or estrogenic activity in preclinical trials. Decreases rhinovirus-induced up-regulation in respiratory epithelial cells and modulate pretranscriptional mechanisms. Reduces intraepithelial eosinophilia and inflammatory cell infiltration (eg, eosinophils, lymphocytes, monocytes, neutrophils, plasma cells).

Budesonide inhaled (Pulmicort Turbuhaler, Rhinocort)

 

This nasal steroid is useful in ETD especially in patients who are also diagnosed with allergic rhinitis.

Fluticasone (Flonase, Flovent, Veramyst)

 

Has extremely potent vasoconstrictive and anti-inflammatory activity. Has a weak hypothalamic-pituitary-adrenocortical axis inhibitory potency when applied topically.

Triamcinolone inhaled (Azmacort, Nasacort AQ)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Ciclesonide (Omnaris)

 

Corticosteroid nasal spray indicated for allergic rhinitis. Prodrug that is enzymatically hydrolyzed to pharmacologic active metabolite C21-desisobutyryl-ciclesonide following intranasal application. Corticosteroids have a wide range of effects on multiple cell types (eg, mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (eg, histamines, eicosanoids, leukotrienes, cytokines) involved in allergic inflammation. Each spray delivers 50 mcg.

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Anti-inflammatory Agent

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Methylprednisolone (Medrol Dose Pack)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Contributor Information and Disclosures
Author

Robert B Meek, MD 

Robert B Meek, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, Association for Research in Otolaryngology

Disclosure: Nothing to disclose.

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.

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.

Acknowledgements

Ari J Goldsmith, MD Chief of Pediatric Otolaryngology, Long Island College Hospital; Associate Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center

Ari J Goldsmith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

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Anatomy of the external and middle ear.
 
 
 
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