Treatment Options for Non-Infectious Otitis Media Using Drops
For non-infectious otitis media, topical steroid drops are the most effective treatment option, with nasal steroid sprays showing similar efficacy to oral steroids while having fewer systemic side effects. 1
Understanding Non-Infectious Otitis Media
Non-infectious otitis media, commonly known as otitis media with effusion (OME), is characterized by fluid accumulation in the middle ear without signs of acute infection. This condition differs from acute otitis externa (AOE) or infectious otitis media, which require antimicrobial treatment.
First-Line Treatment Options
Topical Steroid Drops
- Mometasone furoate nasal spray has shown significant effectiveness in treating OME, with results comparable to systemic steroids 1
- Proper administration technique is crucial:
- Have the patient lie down with the affected ear upward
- Instill enough drops to fill the ear canal
- Maintain position for 3-5 minutes
- Use gentle to-and-fro movement of the ear or press the tragus to help drops penetrate 2
Nasal Steroid Sprays
- Fluticasone propionate nasal spray has demonstrated effectiveness for OME, especially in children with allergic rhinitis 3
- Nasal steroids are particularly beneficial when OME is associated with allergic conditions
- Dosage: One puff in each nostril daily, for up to 3 months 1
Treatment Duration and Monitoring
- Treatment with nasal steroids should typically continue for 2-3 months 1
- Follow-up should occur every 4-6 weeks to assess response
- If no improvement is seen after 3 months of treatment, consider referral to an otolaryngologist 4
Special Considerations
For Patients with Tympanostomy Tubes
- If a tympanostomy tube is present and functioning, non-ototoxic drops such as ciprofloxacin or ofloxacin should be used 4
- Avoid aminoglycoside-containing drops (neomycin, gentamicin) due to risk of ototoxicity 4
For Patients with Perforated Eardrums
- Only use non-ototoxic preparations such as ciprofloxacin or ofloxacin 4
- Ensure proper ear canal cleaning before administering drops 2
Pitfalls and Caveats
- Ear candles should never be used for any ear condition, as they have been shown to cause harm including hearing loss and tympanic membrane perforation 2
- Prolonged use of topical therapy should be limited to prevent fungal external otitis 4
- Water entry into the ear canal should be prevented during treatment by covering the opening with cotton saturated with petroleum jelly 2
- Systemic oral steroids may have limited long-term benefits for OME and carry risk of adverse effects 5, 6
When to Consider Alternative Treatments
- If symptoms persist beyond 3 months despite appropriate treatment
- If hearing loss is significant or worsening
- If there are recurrent episodes despite adequate treatment
- If structural abnormalities are suspected 2
When to Refer to a Specialist
Contact an otolaryngologist if:
- Symptoms persist beyond 3 months
- Hearing loss continues or worsens
- Structural abnormalities are suspected
- The patient has recurrent episodes despite adequate treatment 2, 4
By following these guidelines, most cases of non-infectious otitis media can be effectively managed with topical treatments, minimizing the need for systemic medications or surgical interventions.