From the Guidelines
If your chronic ear pain isn't responding to antihistamines like Zyrtec, Xyzal, hydroxyzine, or nasal steroids like Flonase, you should consult an ENT specialist for proper evaluation. The next steps might include trying a different class of medications such as oral steroids (prednisone, typically 20-40mg daily for 5-7 days) or antibiotics if infection is suspected, as suggested by 1. Pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) may help manage symptoms temporarily, according to 1. Your ear pain could be caused by conditions other than allergies, such as:
- Eustachian tube dysfunction
- Temporomandibular joint disorder
- Infection that requires different treatment Some patients benefit from ear pressure equalization techniques like the Valsalva maneuver (gently blowing out while pinching your nose and keeping your mouth closed) or using a warm compress on the affected ear. Since multiple allergy medications haven't helped, this suggests the underlying cause may not be allergy-related, making professional evaluation essential for proper diagnosis and targeted treatment, as noted in 1. It's also important to consider other potential causes of ear pain, such as dermatologic disorders or malignant otitis externa, and to rule out these conditions through proper evaluation and testing, as discussed in 1. Additionally, the management of chronic pain in patients, as outlined in 1, emphasizes the importance of a comprehensive approach that takes into account the biopsychosocial factors that influence pain. However, the specific management of chronic ear pain should be guided by the most recent and highest quality evidence, which in this case is 1, and should prioritize the use of oral steroids, antibiotics, and pain relievers as needed, while also considering other potential causes of ear pain and referring to an ENT specialist for proper evaluation.
From the Research
Possible Causes of Chronic Ear Pain
- Primary otalgia, which originates from the ear, with common causes including otitis media and otitis externa 2
- Secondary otalgia, which originates outside the ear, with common causes including temporomandibular joint syndrome and dental infections 2
Treatment Options for Chronic Ear Pain
- A trial of symptomatic treatment, imaging studies, and consultation may be reasonable options if the diagnosis is not immediately clear 2
- Amitriptyline has been shown to be an efficient alternative treatment for chronic pain in temporomandibular disorder (TMD) patients 3, 4
- The effectiveness of amitriptyline for chronic TMD pain has been demonstrated in clinical trials, with significant reductions in pain and discomfort 3, 4
Considerations for Treatment
- The probability of response to antidepressant treatment, such as amitriptyline, can continue to increase for up to 3 months 5
- Patient preference for treatment can influence clinical outcomes, with patients who receive their preferred treatment being more likely to achieve better outcomes 6
- Temporomandibular joint syndrome and dental infections should be considered as potential causes of chronic ear pain, and treated accordingly 2