What is the watch and wait approach for otitis media (inflammation of the middle ear) with a dull ear sensation?

From the Guidelines

For a dull ear, a "watch and wait" approach is generally recommended before considering medications like amoxicillin, with a recommended watchful waiting period of 3 months for children with otitis media with effusion (OME) who are not at particular risk for speech, language, or learning problems 1. This approach is based on the fact that many ear issues, particularly mild otitis media (middle ear infection), can improve without antibiotics.

• The watch and wait strategy is particularly appropriate for mild cases in patients without severe symptoms or underlying health conditions.
• During this time, over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.
• If symptoms worsen or don't improve after the watch and wait period, further evaluation and treatment may be necessary, which may include antibiotics like amoxicillin, typically at a dose of 80-90 mg/kg/day divided into two doses for 5-10 days for children, or 500 mg three times daily for adults.
• The most recent and highest quality study, published in 2016 in Nature Reviews Disease Primers, supports the use of a watchful waiting period for children with OME, with ventilation tubes considered an option for children with documented hearing difficulties after 3 months 1.
• Another study, published in 2004 in Otolaryngology--head and neck surgery, also recommends a watchful waiting period for children with OME, with hearing testing and further evaluation considered if symptoms persist or worsen 1.

From the Research

Watch and Wait Approach for Amoxicillin/Clavulanic Acid in Dull Ear Symptoms

• The watch and wait approach is not directly mentioned in the provided studies, but the effectiveness of amoxicillin/clavulanic acid in treating ear infections is discussed 2, 3, 4, 5.
• A study from 1998 compared the clinical effectiveness of azithromycin, amoxicillin/clavulanic acid, and cefaclor in treating acute ear, nose, and throat infections, including otitis media 2.
• Another study from 2011 compared the effectiveness of a single dose of azithromycin extended-release with a 10-day regimen of amoxicillin/clavulanate in children with acute otitis media 3.
• A systematic review and meta-analysis from 2021 compared the efficacy and safety of azithromycin and amoxicillin/clavulanate for treating otitis media in children, finding that azithromycin is comparable to amoxicillin/clavulanate and safer 4.
• A study from 2018 investigated the anti-inflammatory effects of macrolide antibiotics, including azithromycin, on histamine-induced otitis media with effusion in guinea pigs 6.
• A population-based study from 2005 assessed the effectiveness of amoxicillin, azithromycin, cefprozil, and clarithromycin in treating acute otitis media in children, finding that azithromycin was associated with a decreased risk of failure overall compared to amoxicillin 5.

Key Findings

• Azithromycin is comparable to amoxicillin/clavulanate in treating otitis media in children 3, 4.
• Amoxicillin/clavulanate is effective in treating acute otitis media, but may have a higher risk of adverse events compared to azithromycin 2, 3, 4.
• Macrolide antibiotics, including azithromycin, have anti-inflammatory properties that may be beneficial in treating otitis media with effusion 6.
• The watch and wait approach is not explicitly mentioned in the provided studies, but the effectiveness of amoxicillin/clavulanic acid and azithromycin in treating ear infections is discussed 2, 3, 4, 5.