What is a good prescription decongestant for otic (ear) congestion?

From the Guidelines

Pseudoephedrine is the most effective prescription-strength decongestant for ear congestion, with a recommended adult dose of 60mg every 4-6 hours or 120mg in extended-release form every 12 hours, not exceeding 240mg daily. This medication works by constricting blood vessels in the nasal passages and eustachian tubes, reducing swelling and allowing fluid to drain from the middle ear 1. It is essential to note that pseudoephedrine may cause side effects like increased heart rate, elevated blood pressure, and insomnia, so it should be avoided by those with heart conditions, high blood pressure, or anxiety disorders.

Some key points to consider when using pseudoephedrine for ear congestion include:

• Taking it for 3-5 days when experiencing ear congestion due to colds, allergies, or sinus infections
• Using a nasal saline spray and staying hydrated to help thin mucus and improve drainage
• Being aware of the potential for rebound congestion and rhinitis medicamentosa with prolonged use of topical decongestants, as noted in studies 1
• Limiting the use of topical decongestants to no more than 3 to 5 consecutive days without a prolonged intervening drug-free period to avoid rebound congestion and rhinitis medicamentosa 1

It is crucial to weigh the benefits and risks of pseudoephedrine and consider alternative treatments, such as nasal saline sprays and hydration, to manage ear congestion effectively. Additionally, patients should be instructed on the risks of rhinitis medicamentosa and the importance of suspending topical decongestant use to allow the nasal mucosa to recover if necessary 1.

From the Research

Decongestant Options for Ear Congestion

• Pseudoephedrine is a commonly used decongestant that has been shown to be effective in reducing nasal congestion 2, 3, 4.
• Phenylephrine is another decongestant that is available, but its efficacy is limited due to first-pass metabolism and it is not bioavailable in currently recommended doses 2, 4, 5.
• Ephedrine is also a decongestant, but its use is limited due to the risk of severe cardiovascular and neurological adverse events 3.

Considerations for Decongestant Use

• Decongestants should not be used in patients under the age of 15 due to the risk of adverse events 3.
• The use of decongestants should be carefully weighed in patients with allergic rhinitis due to the risk of rebound congestion and other adverse events 2, 3.
• Pseudoephedrine can cause increases in blood pressure and heart rate, particularly at higher doses and with immediate-release preparations 6.

Effective Decongestant Doses

• Pseudoephedrine has been shown to be effective at a dose of 60 mg 4.
• Phenylephrine has been studied at doses of up to 40 mg, but has not been shown to be significantly better than placebo at relieving nasal congestion 5.