Medscape is available in 5 Language Editions – Choose your Edition here.


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.



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


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.


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.


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.

Contributor Information and Disclosures

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.


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.

  1. Swarts JD, Alper CM, Luntz M, Bluestone CD, Doyle WJ, Ghadiali SN, et al. Panel 2: Eustachian tube, middle ear, and mastoid--anatomy, physiology, pathophysiology, and pathogenesis. Otolaryngol Head Neck Surg. 2013 Apr. 148(4 Suppl):E26-36. [Medline].

  2. Hasegawa K, Tsugawa Y, Cohen A, et al. Infectious Disease-related Emergency Department Visits Among Children in the United States. Pediatr Infect Dis J. 2015 Apr 8. [Medline].

  3. Handzic J, Radic B, Bagatin T, Savic A, Stambolija V, Nevajda B. Hearing in children with otitis media with effusion--clinical retrospective study. Coll Antropol. 2012 Dec. 36(4):1273-7. [Medline].

  4. Doyle WJ, Alper CM, Buchman CA, Moody SA, Skoner DP, Cohen S. Illness and otological changes during upper respiratory virus infection. Laryngoscope. 1999 Feb. 109(2 Pt 1):324-8. [Medline].

  5. Niemelä M, Pihakari O, Pokka T, Uhari M. Pacifier as a risk factor for acute otitis media: A randomized, controlled trial of parental counseling. Pediatrics. 2000 Sep. 106(3):483-8. [Medline].

  6. Contencin P, Maurage C, Ployet MJ, Seid AB, Sinaasappel M. Gastroesophageal reflux and ENT disorders in childhood. Int J Pediatr Otorhinolaryngol. 1995 Jun. 32 Suppl:S135-44. [Medline].

  7. Tarabichi M, Najmi M. Visualization of the eustachian tube lumen with Valsalva computed tomography. Laryngoscope. 2015 Mar. 125(3):724-9. [Medline].

  8. Sudhoff H, Schröder S, Reineke U, Lehmann M, Korbmacher D, Ebmeyer J. [Therapy of chronic obstructive eustachian tube dysfunction : Evolution of applied therapies]. HNO. 2013 Jun. 61(6):477-82. [Medline].

  9. Gluth MB, McDonald DR, Weaver AL, Bauch CD, Beatty CW, Orvidas LJ. Management of eustachian tube dysfunction with nasal steroid spray: a prospective, randomized, placebo-controlled trial. Arch Otolaryngol Head Neck Surg. 2011 May. 137(5):449-55. [Medline].

  10. Haddad J Jr, Saiman L, San Gabriel P, et al. Nonsusceptible Streptococcus pneumoniae in children with chronic otitis media with effusion and recurrent otitis media undergoing ventilating tube placement. Pediatr Infect Dis J. 2000 May. 19(5):432-7. [Medline].

  11. Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J. 2000 Mar. 19(3):187-95. [Medline].

  12. Asbjornsen A, Holmefjord A, Reisaeter S, et al. Lasting auditory attention impairment after persistent middle ear infections: a dichotic listening study. Dev Med Child Neurol. 2000 Jul. 42(7):481-6. [Medline].

  13. Bernstein JM. Immunologic reactivity in the middle ear in otitis media with effusion. Otolaryngol Clin North Am. 1991 Aug. 24(4):845-58. [Medline].

  14. Block SL, Hedrick J, Harrison CJ, et al. Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. Pediatr Infect Dis J. 2004 Sep. 23(9):829-33. [Medline].

  15. Bluestone CD. Epidemiology and pathogenesis of chronic suppurative otitis media: implications for prevention and treatment. Int J Pediatr Otorhinolaryngol. 1998 Jan. 42(3):207-23. [Medline].

  16. Casey JR, Pichichero ME. Changes in frequency and pathogens causing acute otitis media in 1995-2003. Pediatr Infect Dis J. 2004 Sep. 23(9):824-8. [Medline].

  17. Conrad DA. Should acute otitis media ever be treated with antibiotics?. Pediatr Ann. 1998 Feb. 27(2):66-7, 70-4. [Medline].

  18. Contencin P, Narcy P. Nasopharyngeal pH monitoring in infants and children with chronic rhinopharyngitis. Int J Pediatr Otorhinolaryngol. 1991 Oct. 22(3):249-56. [Medline].

  19. Daly KA, Giebink GS. Clinical epidemiology of otitis media. Pediatr Infect Dis J. 2000 May. 19(5 Suppl):S31-6. [Medline].

  20. Ghaffar F, Barton T, Lozano J, et al. Effect of the 7-valent pneumococcal conjugate vaccine on nasopharyngeal colonization by Streptococcus pneumoniae in the first 2 years of life. Clin Infect Dis. 2004 Oct 1. 39(7):930-8. [Medline].

  21. Heikkinen T. Role of viruses in the pathogenesis of acute otitis media. Pediatr Infect Dis J. 2000 May. 19(5 Suppl):S17-22; discussion S22-3. [Medline].

  22. Ilicali OC, Keles N, Deger K, Savas I. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999 Jul. 125(7):758-62. [Medline].

  23. Meek RB 3rd, McGrew BM, Cuff CF, Berrebi AS, Spirou GA, Wetmore SJ. Immunologic and histologic observations in reovirus-induced otitis media in the mouse. Ann Otol Rhinol Laryngol. 1999 Jan. 108(1):31-8. [Medline].

  24. Niemelä M, Uhari M, Möttönen M, Pokka T. Costs arising from otitis media. Acta Paediatr. 1999 May. 88(5):553-6. [Medline].

  25. Pelton SI. Otitis media: re-evaluation of diagnosis and treatment in the era of antimicrobial resistance, pneumococcal conjugate vaccine, and evolving morbidity. Pediatr Clin North Am. 2005 Jun. 52(3):711-28, v-vi. [Medline].

  26. Pelton SI, Loughlin AM, Marchant CD. Seven valent pneumococcal conjugate vaccine immunization in two Boston communities: changes in serotypes and antimicrobial susceptibility among Streptococcus pneumoniae isolates. Pediatr Infect Dis J. 2004 Nov. 23(11):1015-22. [Medline].

  27. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr. 115(4):1048-57. [Medline].

  28. Pichichero ME, Reiner SA, Brook I, et al. Controversies in the medical management of persistent and recurrent acute otitis media. Recommendations of a clinical advisory committee. Ann Otol Rhinol Laryngol Suppl. 2000 Aug. 183:1-12. [Medline].

  29. Rinaldo A, Ferlito A. The pathology and clinical features of "glue ear": a review. Eur Arch Otorhinolaryngol. 2000. 257(6):300-3. [Medline].

  30. Rovers MM, Straatman H, Ingels K, van der Wilt GJ, van den Broek P, Zielhuis GA. The effect of ventilation tubes on language development in infants with otitis media with effusion: A randomized trial. Pediatrics. 2000 Sep. 106(3):E42. [Medline].

  31. Rovers MM, Zielhuis GA, Straatman H, Ingels K, van der Wilt GJ, van den Broek P. Prognostic factors for persistent otitis media with effusion in infants. Arch Otolaryngol Head Neck Surg. 1999 Nov. 125(11):1203-7. [Medline].

  32. Ruuskanen O, Arola M, Putto-Laurila A, et al. Acute otitis media and respiratory virus infections. Pediatr Infect Dis J. 1989 Feb. 8(2):94-9. [Medline].

  33. Shaw CB, Obermyer N, Wetmore SJ, Spirou GA, Farr RW. Incidence of adenovirus and respiratory syncytial virus in chronic otitis media with effusion using the polymerase chain reaction. Otolaryngol Head Neck Surg. 1995 Sep. 113(3):234-41. [Medline].

  34. Skull SA, Morris PS, Yonovitz A, et al. Middle ear effusion: rate and risk factors in Australian children attending day care. Epidemiol Infect. 1999 Aug. 123(1):57-64. [Medline].

  35. Takahashi M, Peppard J, Harris JP. Immunohistochemical study of murine middle ear and Eustachian tube. Acta Otolaryngol. 1989 Jan-Feb. 107(1-2):97-103. [Medline].

  36. Uhari M, Hietala J, Tuokko H. Risk of acute otitis media in relation to the viral etiology of infections in children. Clin Infect Dis. 1995 Mar. 20(3):521-4. [Medline].

  37. US Otitis Media Guideline Panel, Stool SE, US Agency for Health Care Policy and Research. Otitis media with effusion in young children/Otitis Media Guideline Panel. Rockville, Md: US Dept. of Health and Human Services, Public Health Service; 1994. Clinic practice gudeline, No. 12.

  38. Wright CG, Meyerhoff WL. Pathology of otitis media. Ann Otol Rhinol Laryngol Suppl. 1994 May. 163:24-6. [Medline].

  39. Zhou F, Shefer A, Kong Y, Nuorti JP. Trends in acute otitis media-related health care utilization by privately insured young children in the United States, 1997-2004. Pediatrics. 2008 Feb. 121(2):253-60. [Medline].

  40. Zielhuis GA, Gerritsen AA, Gorissen WH, et al. Hearing deficits at school age; the predictive value of otitis media in infants. Int J Pediatr Otorhinolaryngol. 1998 Aug 1. 44(3):227-34. [Medline].

Anatomy of the external and middle ear.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.