From the Guidelines
For ear pain associated with throat swelling and radiation pain, I strongly recommend starting with over-the-counter pain relievers such as acetaminophen (500-1000mg every 6 hours) or nonsteroidal anti-inflammatory drugs like ibuprofen (400-600mg every 6-8 hours) to reduce inflammation and pain, as supported by the clinical practice guideline for acute otitis externa 1.
When managing ear pain, it's essential to assess the severity of discomfort and use a suitable pain scale, such as a visual analog scale, to determine the level of pain 1. The use of analgesics like acetaminophen or nonsteroidal anti-inflammatory drugs is crucial in achieving comfort and reducing pain, especially during the acute phase of diffuse AOE 1.
Some key points to consider when using analgesics for ear pain include:
- Convenience, ease of use, and cost make orally administered analgesics the preferred route of administration whenever possible 1.
- Early treatment at an appropriate starting dose is always indicated, and administering analgesics at fixed intervals rather than on a pro re nata (prn) basis may be more effective 1.
- Nonpharmacologic therapies such as heat or cold, relaxation, and distraction are of unproven value, but a warm compress to the affected ear for 15-20 minutes can provide comfort.
- If symptoms are severe or persist beyond 2-3 days, medical attention is necessary as you may need antibiotics if there's an infection or stronger prescription medications for pain management.
It's also important to note that opioids like fentanyl citrate, morphine sulfate, and hydromorphone hydrochloride may be indicated for procedure-related pain and moderate to severe around-the-clock pain, but their use should be guided by the recognition that pain is easier to prevent than treat, and prescribing a limited number of doses for the initial treatment period can mitigate risks of opioid misuse or diversion 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Options for Ear Pain and Throat Swelling
- The ear pain and throat swelling may be related to inflammation, and medications that reduce inflammation can be helpful 2, 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and analgesics like paracetamol (acetaminophen) can be used to relieve pain and reduce inflammation 2, 3, 4.
- Paracetamol is often preferred due to its better tolerance and lower risk of gastrointestinal side effects compared to NSAIDs 4.
- However, the effectiveness of paracetamol for acute pain is still debated, and its use should be considered on a case-by-case basis 5.
Considerations for Medication Use
- The choice of medication should be tailored to the individual patient's needs and medical history 3.
- Patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease should use NSAIDs with caution 3.
- Paracetamol can be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder, but lower doses should be used 3.
- Opioid medications may be considered for severe or refractory acute pain, but their use should be minimized due to the risk of addiction and other side effects 3.