Possibilities of effective topical therapy in treatment of acute otitis media in children: A review

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Abstract

Acute otitis media (AOM) is a common infection of the middle ear in children with predominant symptoms of pain and hearing impairment. If antibiotics are prescribed, they take time to act on the inflammatory process, so the main focus is on relieving pain. Topical anesthetics have the advantage of having fewer systemic side effects when analgesic is used. The review covers a systematic analysis of the literature on the problem of AOM in children for the period from 1990 to 2021. Analgesic ear drops with lidocaine and phenazone can provide first-line pain relief for otitis media without systemic side effects such as gastrointestinal disorders and nausea and can maintain a wait-and-see attitude towards saving antibiotics. A combined drug containing a combination of the anesthetic lidocaine and the anti-inflammatory drug phenazone shows optimal action to eliminate pain and inflammation in children with AOM. The drug, which is recommended from the birth of a child and included in the National clinical guidelines for the treatment of AOM (2021), can be prescribed by a pediatrician and a general and family practitioner.

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About the authors

Tatiana I. Garashchenko

Pirogov Russian National Research Medical University; National Medical Research Center for Otorhinolaryngology

Email: payganova-natella@yandex.ru
ORCID iD: 0000-0002-5024-6135

D. Sci. (Med.), Prof., Pirogov Russian National Research Medical University, National Medical Research Center for Otorhinolaryngology

Russian Federation, Moscow; Moscow

Lidia I. Ilenko

Pirogov Russian National Research Medical University

Email: payganova-natella@yandex.ru
ORCID iD: 0000-0001-8375-4569

D. Sci. (Med.), Prof., Pirogov Russian National Research Medical University

Russian Federation, Moscow

Natella E. Payganova

Dr. Zaitsev ENT Clinic

Author for correspondence.
Email: payganova-natella@yandex.ru
ORCID iD: 0000-0001-7823-5422

Cand. Sci. (Med.), Dr. Zaitsev Clinic

Russian Federation, Moscow

References

  1. Клинические рекомендации. Отит средний острый. М., 2021. Режим доступа: https://cr.minzdrav.gov.ru/schema/314_2. Ссылка активна на 24.04.2022 [Klinicheskie rekomendatsii. Otit srednii ostryi. Moscow, 2021. Available at: https://cr.minzdrav.gov.ru/schema/314_2. Accessed: 24.04.2022 (in Russian)].
  2. Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: A systematic review. JAMA. 2010;304(19):2161-9. doi: 10.1001/jama.2010.1651
  3. Kaur R, Morris M, Pichichero ME. Epidemiology of acute otitis media in the postpneumococcal conjugate vaccine era. Pediatrics. 2017;140(3):e20170181. doi: 10.1542/peds.2017-0181
  4. Meng W, Huang DD, Li GF, et al. Evaluation of Clinical Graded Treatment of Acute Nonsuppurative Otitis Media in Children with Acute Upper Respiratory Tract Infection. Neural Plast. 2021;2021:5517209. doi: 10.1155/2021/5517209
  5. Крючко Т.А., Шпехт Т.В., Ткаченко О.Я. Острый средний отит у детей: современный взгляд на проблему. Здоровье ребенка. 2010;2:23-6 [Kriuchko TA, Shpekht TV, Tkachenko OIa. Ostryi srednii otit u detei: sovremennyi vzgliad na problemu. Child’s Health. 2010;2:23-6 (in Russian)].
  6. Карпова Е.П., Бурлакова К.Ю. Воспалительные заболевания среднего уха у детей. Медицинский Совет. 2017;9:65-9 [Karpova EP, Burlakova KY. Inflammatory diseases of the middle ear in children. Meditsinskiy sovet = Medical Council. 2017;(9):65-9 (in Russian)]. doi: 10.21518/2079-701X-2017-9-65-69
  7. Leberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99. doi: 10.1542/peds.2012-3488
  8. Gaddey HL, Wright MT, Nelson TN. Otitis Media: Rapid Evidence Review. Am Fam Physician. 2019;100(6):350-6.
  9. Turner D, Leibovitz E, Aran A, et al. Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach. Pediatr Infect Dis J. 2002;21(7):699-744. doi: 10.1097/00006454-200207000-00013
  10. Бойкова Н.Э., Рыбалкин С.В. Острый средний отит у детей. Стандарты лечения. Педиатрия. Consilium Medicum. 2017;3:35-8 [Boykova NE, Rybalkin SV. Acute otitis media in children: treatment standards. Pediatrics. Consilium Medicum. 2017;3:35-8 (in Russian)].
  11. Самсыгина Г.А., Минасян В.С. Острый средний отит у детей: принципы диагностики и антибактериальной терапии. Педиатрия. Consilium Medicum. 2007;9(1) [Samsygina GA, Minasian VS. Ostryi srednii otit u detei: printsipy diagnostiki i antibakterial'noi terapii. Pediatrics. Consilium Medicum. 2007;9(1) (in Russian)].
  12. Guidelines & Protocols Advisory committee. Acute otitis media (AOM) & Otitis media with Effusion (OME), 2010. Available at: https://www.howdenmedicalclinic.com/wp-content/uploads/2018/03/otitis.pdf. Accessed: 24.04.2022.
  13. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451-65. doi: 10.1542/peds.113.5.1451
  14. Suzuki HG, Dewez JE, Nijman RG, Yeung S. Clinical practice guidelines for acute otitis media in children: A systematic review and appraisal of European national guidelines. BMJ Open. 2020;10(5):e035343. doi: 10.1136/bmjopen-2019-035343
  15. Carlens J, Schütz K, Baumann U. Akute Otitis media. Monatsschr Kinderheilkd. 2016;164:349-58. doi: 10.1007/s00112-016-0082-2
  16. Lieberthal AS, Carroll AE, Chonmaitree T, et al. From the American Academy of Pediatrics: The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99. doi: 10.1542/peds.2012-3488
  17. Uddman R, Grunditz T, Larsson A, Sundler F. Sensory innervation of the ear drum and middle-ear mucosa: Retrograde tracing and immunocytochemistry. Cell Tissue Res. 1988;252(1):141-6. doi: 10.1007/BF00213835
  18. Ullrich D, Aurbach G, Drobik C. A prospective study of hyperlipidemia as a pathogenic factor in sudden hearing loss. Eur Arch Otorhinolaryngol. 1992;249(5):273-6. doi: 10.1007/BF00714491
  19. Reiß M. Facharztwissen HNO-Heilkunde: Differenzierte Diagnostik und Therapie. Springer Science & Business Media, 2009.
  20. Rosen S. The tympanic plexus: an anatomic study. Arch Otolaryngol (1925). 1950;52(1):15-8. doi: 10.1001/archotol.1950.00700030034003
  21. Hoskison E, Daniel M, Al-Zahid S, et al. Drug delivery to the ear. Ther Deliv. 2013;4(1):115-24. doi: 10.4155/tde.12.130
  22. Uhde G. The problem of permeability and anesthesia of the tympanic membrane. AMA Arch Otolaryngol. 1957;66(4):391-407. doi: 10.1001/archotol.1957.03830280021004
  23. Abramson M. Topical anesthesia of the tympanic membrane. Arch Otolaryngol. 1969;90(2):147-9. doi: 10.1001/archotol.1969.00770030149009
  24. Schmidt RM, Rosenkranz HS. Antimicrobial activity of local anesthetics: lidocaine and procaine. J Infect Dis. 1970;121(6):597-607. doi: 10.1093/infdis/121.6.597
  25. Spiro DM, Tay K-Y, Arnold DH, et al. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006;296(10):1235-41. doi: 10.1001/jama.296.10.1235
  26. Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015;2015(6):CD000219. doi: 10.1002/14651858.CD000219.pub4
  27. Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2004;(1):CD000219. doi: 10.1002/14651858.CD000219.pub2
  28. Бойкова Н.Э., Гаращенко Т.И. Рациональный выбор антимикробной терапии при остром среднем отите у детей. Медицинский Совет. 2017;1:232-6 [Boikova NE, Garaschenko TI. Rational choice of antibiotic therapy in acute otitis media in children. Meditsinskiy sovet = Medical Council. 2017;1:232-6 (in Russian)]. doi: 10.21518/2079-701X-2017-1-232-236
  29. Rosa-Olivares J, Porro A, Rodriguez-Varela M, et al. Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner. Pediatr Rev. 2015;36(11):480-6. doi: 10.1542/pir.36-11-480
  30. Hay AD, Costelloe C, Redmond NM, et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial. BMJ. 2008;337:a1302. doi: 10.1136/bmj.a1302
  31. Vergison A, Dagan R, Arguedas A, et al. Otitis media and its consequences: beyond the earache. Lancet Infect Dis. 2010;10(3):195-203. doi: 10.1016/S1473-3099(10)70012-8
  32. Foxlee R, Johansson AC, Wejfalk J, et al. Topical analgesia for acute otitis media (with update 11 feb 2011). Cochrane Database Syst Rev. 2006;2006(3):CD005657. doi: 10.1002/14651858.CD005657.pub2
  33. Рязанцев С.В., Захарова Г.П., Павлова С.С., Иванов Н.И. Препараты с комбинацией лидокаина/феназона как один из ключевых элементов терапии неосложненного острого среднего отита. Эффективная фармакотерапия. 2021;17(27):10-4 [Ryazantsev SV, Zakharova GP, Pavlova SS, Ivanov NI. Drugs with a combination of lidocaine/phenazone as one of the key elements of the treatment of uncomplicated acute otitis media. Effektivnaia farmakoterapiia. 2021;17(27):10-4 (in Russian)]. doi: 10.33978/2307-3586-2021-17-27-10-14
  34. Verleye M, Huilard I, Gillardin JM. Phenazone potentiates the local anaesthetic effect of lidocaine in mice. Pharmacol Res. 2000;41(5):539-42. doi: 10.1006/phrs.1999.0619
  35. Минасян В.С., Бондаренко М.Г. Применение препарата Отипакс при остром среднем отите у новорожденных и детей грудного возраста. Вестник оториноларингологии. 2004;4:44-5 [Minasyan VS, Bondarenko MG. Using the drug otipax in acute otitis media in newborns and infants. Bulletin of Otorhinolaryngology. 2004;4:44-5 (in Russian)].
  36. Григорьев К.И., Григорян А.К., Запруднов А.М. Отипакс при лечении острого среднего отита у детей. Российский вестник перинатологии и педиатрии. 2000;2:45-8 [Grigor'ev KI, Grigorian AK, Zaprudnov AM. Otipaks pri lechenii ostrogo srednego otita u detei. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2000;2:45-8 (in Russian)].
  37. Казюкова Т.В., Китайгородский А.П., Мазурина Н.А. Применение ушных капель Отипакс в терапии респираторных инфекций у детей раннего возраста. Педиатрия. 1996;5:64 [Kaziukova TV, Kitaigorodskii AP, Mazurina NA. Primenenie ushnykh kapel' Otipaks v terapii respiratornykh infektsii u detei rannego vozrasta. Pediatriia. 1996;5:64 (in Russian)].
  38. Francois M. Efficacy and safety of phenazone-lidocaine eardrops (Otipax) in infants and children with congestive otitis. Ann Pediatr (Paris). 1993;40(7):481-4.
  39. Wood DN, Nakas N, Gregory CW. Clinical trials assessing ototopical agents in the treatment of pain associated with acute otitis media in children. Int J Pediatr Otorhinolaryngol. 2012;76(9):1229-35. doi: 10.1016/j.ijporl.2012.05.022
  40. Thornton K, Parrish F, Swords C. Topical vs. systemic treatments for acute otitis media. Pediatr Nurs. 2011;37(5):263-7,242.

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2. Fig. 1. Efficacy of the study drug for the treatment of acute otitis media in neonates and infants [35].

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3. Fig. 2. Otoscopy findings of a 7-year-old patient with severe right-sided otalgia due to congestive otitis media: a – view of the tympanic membrane before application of the study drug: opaque, thickened, without bulging in the superior posterior quadrant, hyperemic in the area of malleolus handle; b – 5 min after application of the drug: fluid at the bottom of the external auditory canal in the middle ear canal transition area; c – 25 min after application of the drug: the anterior and inferior zones of the tympanic membrane became translucent again, no hyperemia was observed in the area of the malleolus handle [35].

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