Treatment of pain in the ear

The pronounced staginess of the process of acute otitis media, as the main cause of ear pain, suggests an individual approach to treatment in each of these stages. Of particular importance at all stages is the restoration of the function of the auditory tube, which includes the use of vasoconstrictive drops in the nose, topical glucocorticoids endonasal, blasting of the auditory tube, catheterization.

It is also necessary to treat the diseases that led to tubal dysfunction, and consequently, to acute otitis media: acute and exacerbations of chronic nasopharyngitis, sinusitis, acute rhinitis. Of great importance in the treatment of these diseases is the normalization of the pathological viscous secretion of the nasal cavity, the paranasal sinuses and the auditory tube. Therefore, in the complex treatment of acute otitis it is advisable to include so-called secretolitic drugs, one of which is sinupret.

For topical treatment of otitis, ear drops are used, containing anti-inflammatory drugs and anesthetics. The most advantageous is the combination of these components in a single preparation. Combined drug for the treatment of acute otitis is otipax, containing senazone - a nonsteroidal anti-inflammatory drug and lidocaine - a local anesthetic.

The local use of antibacterial drugs in the treatment of acute otitis media is very limited. This is due to the fact that the antibiotics that make up the ear drops practically do not penetrate through the unperforated tympanic membrane.

With perforated otitis, antibiotic solutions for transtimpanal administration are allowed. However, the use of ear drops containing antibiotics, in violation of the integrity of the tympanic membrane should be treated with extreme caution. It must be remembered that neomycin, gentamicin, polymyxin B and some other antibiotics that are part of most ear drops have an ototoxic effect, and the risk of their use can be high.

Antibiotics applied topically do not replace systemic antibacterial therapy, since they do not affect the flora of the nasal cavity, paranasal sinuses and nasopharynx - the cause of otitis. In most cases, especially when the patient has severe somatic pathology (diabetes mellitus, kidney and blood diseases), antibiotics are prescribed for systemic use. There are three conditions for the effectiveness of antibiotics:

• the sensitivity of the pathogen to the antibiotic;
• the concentration of antibiotic in middle ear fluids and serum above the MPC of the pathogen;
• the concentration in the blood serum above the MPC for 40-50% of the time between doses of the drug.

Oral preparations that provide these conditions, and therefore the leading drugs for empirical therapy of acute otitis media in outpatient practice, should be considered amoxicillin, since it is most active against penicillin-resistant pneumococci, as well as macrolide antibiotics. With the stability of kamoksitsillinu pathogens, with persistent (recurrent) average otitis - appointed amoxicillin with clavulanic acid (amoksiklav), cephalosporins and the last generation of fluoroquinolones.

The use of fluoroquinolones in uncomplicated forms of acute otitis media should be treated with caution. We must not forget that they are still considered as reserve drugs, therefore, their appointment is more appropriate if there is a high risk of development or a complication of otitis media, and in cases of ineffective antibacterial therapy with other drugs.

Modes of dosing of the main oral and parenteral antibiotics in the treatment of acute otitis media

Oral preparations
Antibiotic	Dosing regimen in adults	Dosage regimen in children	Relationship with food intake
Preparations of the first choice:
Amoxicillin	500 mg once per day	40 mg / kg / day in 3 divided doses	Regardless of food
Amoxicillin / clavulanate (amoksiklav)	625 mg once daily or 875 mg twice daily	50 mg / kg / day in 3 divided doses	While eating
Spiramycin (rovatsid)	3 million ME 3 times / day	1.5 million IU / 20 kg / day in 3 divided doses	Before meals
Alternative preparations:
Azithromycin	500 mg1 times a day, 3 days	10 mg / kg / day in 1 reception, 3 days	1 hour before meals
Midekamycin	400 mg 3 times a day	30-50 mg / kg in 2 divided doses	Before eating
Cefuroxime	250 mg twice daily	30 mg / kg / day in 2 divided doses	While eating
Cefaclor	500 mg 3 times a day	40 mg / kg / day in 3 divided doses	Regardless of food