The treatment approaches for otitis media and otitis externa differ significantly due to the distinct pathophysiology and anatomical locations of these conditions.
Otitis media
- Analgesics: Pain management is a priority in acute otitis media (AOM). Guidelines recommend the use of ibuprofen or acetaminophen for otalgia
- Systemic antibiotics: Systemic antibiotics such as amoxicillin or amoxicillin/clavulanic acid are recommended for 10 days in patients with risk factors for unfavorable evolution, such as those under 2 years old or with spontaneous otorrhea
- Decongestants and corticosteroids: The use of systemic or topical decongestants and corticosteroids is not recommended in patients with AOM
- Cerumen removal: Cerumen removal from the external auditory canal may be considered, performed by an appropriately trained professional
- Adenoidectomy: Adenoidectomy may be considered in preschool-aged patients scheduled for first-time ventilation tube insertion for recurrent AOM
Otitis externa
- Analgesics: Pain management is also a priority in acute otitis externa (AOE). Analgesics should be prescribed based on the severity of pain
- Topical therapy: Topical preparations are recommended for initial therapy of diffuse, uncomplicated AOE. Non-ototoxic topical preparations should be prescribed when the patient has a known or suspected perforation of the tympanic membrane
- Systemic antibiotics: Systemic antimicrobials are not recommended as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy
- Specific circumstances: In patients with noninvasive Aspergillus otitis externa, mechanical cleansing of the external auditory canal and administration of topical antifungals or boric acid is recommended
In conclusion, the treatment of otitis media primarily involves systemic antibiotics and analgesics, while otitis externa is typically managed with topical therapy and analgesics. The choice of treatment should be guided by the specific characteristics of the patient and the disease.