From the Guidelines
Persistent ear fullness after antibiotic treatment may require additional interventions beyond antibiotics, and the most effective approach is to try nasal decongestants, nasal saline rinses, and oral antihistamines, with consideration of prescription steroid nasal sprays or Eustachian tube balloon dilation if symptoms persist. The ear fullness often results from continued Eustachian tube dysfunction that prevents proper middle ear ventilation and fluid drainage, even after the initial infection has been treated 1. First, try nasal decongestants like pseudoephedrine (30-60mg every 4-6 hours) or oxymetazoline nasal spray (2 sprays per nostril twice daily for no more than 3 days) to reduce congestion that may be blocking the Eustachian tube. Combine this with nasal saline rinses twice daily and oral antihistamines such as loratadine (10mg daily) or cetirizine (10mg daily) if allergies are suspected. Perform the Valsalva maneuver (pinching your nose while gently blowing with your mouth closed) several times daily to help equalize pressure. If these measures don't provide relief within 1-2 weeks, see an ENT specialist as you may need prescription steroid nasal sprays like fluticasone (1-2 sprays per nostril daily) or possibly Eustachian tube balloon dilation for persistent dysfunction.
Some key points to consider:
- Middle ear effusion following an episode of AOM often takes time to resolve, with persistence of effusion in 70% of ears at 2 weeks, 40% at 1 month, 20% at 2 months, and 10% at 3 months 1.
- Tympanostomy tube insertion in children with recurrent AOM decreased the average number of AOM episodes by about 2.5 per child-year in 2 RCTs that did not exclude children with persistent effusion at the time of trial entry 1.
- The primary rationale for offering tympanostomy tubes to children with recurrent AOM and persistent MEE is to reduce the incidence of future infections, with additional benefits including decreased pain and the ability to manage such infection with topical antibiotic eardrops 1. However, the most recent and highest quality study 1 suggests that tympanostomy tubes can improve quality of life for children with chronic OME, recurrent AOM, or both, and that the risks of tube insertion must be balanced against the risks of chronic OME, recurrent otitis media, or both.
Given the potential benefits and risks, the most appropriate course of action is to try conservative management with nasal decongestants, nasal saline rinses, and oral antihistamines, with consideration of prescription steroid nasal sprays or Eustachian tube balloon dilation if symptoms persist, and to consult an ENT specialist for further evaluation and management.
From the Research
Treatment for Persistent Ear Fullness
- The treatment for persistent ear fullness after antibiotic treatment is not directly addressed in the provided studies, but some information can be inferred from the studies on related topics.
- According to 2, if the patient has a persistent middle ear effusion (MEE) after antibiotic treatment, the clinician may consider continuing the same or another antimicrobial for a second 10-day course, or relieving the pressure by tympanocentesis or myringotomy.
- A study on myringotomy and tube for relief of patulous eustachian tube symptoms 3 found that the treatment either eliminated or substantially reduced symptoms in 53% of ears, suggesting that this procedure may be effective in relieving ear fullness in some cases.
- However, the other studies do not provide direct evidence on the treatment of persistent ear fullness after antibiotic treatment.
Related Conditions and Treatments
- Acute otitis externa, an inflammatory condition of the ear canal, can be treated with topical antimicrobials containing steroids, which were found to be significantly more effective than placebo drops 4.
- Antibiotic prophylaxis in clean and clean-contaminated ear surgery was found to have no strong evidence of reducing postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis, and graft failure 5.
- Factors affecting persistent tympanic membrane perforation after tympanostomy tube removal in children were evaluated in a study 6, which found that patient characteristics such as age at time of tube removal and number of tubes received, as well as ear drum characteristics such as size of perforation and presence of tympanosclerosis, were significantly associated with persistent perforations.