Otalgias: ear pain

Otalgias: ear pain

  1. Otitis media: bacterial infection requires antibiotic
    1. Augmentin
      • Amoxicillin at a dosage of 80 to 90 mg/kg/day divided BID for 5 to 10 days is the recommended first-line antibiotic
        1. Amoxicillin 400mg/5ml (5ml = 1 teaspoon) oral suspension – Take 2 teaspoons q12hrs X 10 days.
      • If allergic to Penicillin: Bactrim DS
        1. SMX-TMP (Bactrim) 200-40mg / 5ml oral suspension – take 2 teaspoons bid. 200ml total (10 days).
      • If allergic to Penicillin and Bactrim: Azithromycin 500mg PO qd for 5 days.
      • Another option: ear drops – Foxitin drops?
    2. Antipyretic:
      • Acetaminophen 10-15 mg/kg PO q4-6hr PRN fever

3. Analgesic: Ibuprofen 10-15 mg/kg PO q4-6hr PRN fever/pain

  1. Otitis externa: “swimmer’s ear,” may also be from putting in ear plugs after showering
    1. Antibiotic drops into ears: Ciprodex 0.3-0.1% otic suspension. 3-4gtts ear canal bid.
    2. Avoid swimming, avoid putting ear plugs into ears right after taking a shower.
  2. Cerumenosis (cerumen impaction causing ear discomfort):
    1. “Ear Wax” occludes canal – Carbamide peroxide/ Glycerin soln, otic: 5-10 drops in each ear for at least 15 minutes twice a day for up to 4 days.
    2. Needs to be virtually impacted; not just partial
    3. Lavage results in symptom resolution [request nurse to use a water pick to remove cerumen out of both ears during appointment]
    4. Normal TM seen after lavage
      1. Patient reports decrease/absence of ear pain and regaining ability to hear out of ears following cerumen dis-impaction.

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