From the Guidelines
Chronic otitis media is typically managed with a combination of medical treatments, preventive measures, and surgical options like tympanostomy tubes to improve drainage and reduce the risk of complications. The treatment approach depends on the underlying cause, severity, and duration of the infection, as well as the patient's overall health and medical history.
Medical Treatments
- Antibiotic ear drops like ciprofloxacin/dexamethasone (Ciprodex) or ofloxacin are usually prescribed for 7-10 days, with 3-4 drops in the affected ear twice daily 1.
- Oral antibiotics such as amoxicillin (500mg three times daily for adults) may be necessary for more severe infections.
- Pain can be managed with over-the-counter medications like acetaminophen or ibuprofen.
- For fungal infections, antifungal drops like clotrimazole are effective.
Preventive Measures
- Keeping the ear dry is crucial—avoid swimming or use earplugs, and gently dry ears after bathing.
- A healthcare provider may need to clean the ear canal professionally to remove debris and improve medication effectiveness.
- Chronic infections often stem from persistent moisture, anatomical factors, or immune system issues, so addressing underlying causes is essential.
Surgical Options
- Tympanostomy tubes can improve quality of life (QOL) for children with chronic OME, recurrent AOM, or both, by providing a mechanism for drainage and administration of topical antibiotic therapy for persistent AOM 1.
- Adenoidectomy may be considered in conjunction with tympanostomy tube insertion for children over 4 years old, as it can reduce the prevalence of middle ear effusion and achieve hearing outcomes comparable to tube insertion alone 1.
Follow-up and Monitoring
- Regular follow-up appointments are important to monitor healing and prevent recurrence.
- Further evaluation may be needed to rule out complications or consider additional treatment options if symptoms persist despite initial treatment.
From the FDA Drug Label
The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute otitis media is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5.
The treatment options for chronic otitis media are not directly addressed in the provided drug labels. However, for acute otitis media, the recommended treatment options using azithromycin include:
- A single dose of 30 mg/kg
- 10 mg/kg once daily for 3 days
- 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5 2, 2, 2
From the Research
Treatment Options for Chronic Otitis Media
- The first-line drug for otitis media is amoxicillin, with effective second-line drugs including trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime 3
- For chronic otitis media with effusion, a combination of azithromycin and acetylcysteine may be useful in treatment, with studies showing improvement in tympanogram measurements 4
- Ciprofloxacin has been shown to be effective in the management of chronic ear disease, with 95% of patients completing therapy showing improvement or cure 5
- Topical ciprofloxacin (0.2%) has been found to be the most effective regimen for the treatment of chronic otitis media, compared to oral ciprofloxacin and topical polymyxin and neomycin 6
- A comparison of topical ciprofloxacin and gentamicin found that ciprofloxacin was more efficacious and efficient in the treatment of chronic otitis media, with 88% of patients cured compared to 30% with gentamicin 7
Antibiotic Therapy
- Antibiotic prophylaxis may be beneficial for children with recurrent infections 3
- The choice of antibiotic should consider factors such as proven efficacy, cost, side effect profile, compliance issues, spectrum of coverage, and the age of the child 3
Surgical Intervention
- Referral for insertion of tympanostomy tubes may be appropriate for patients with documented language delay and/or significant medical complications 3