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Meta-Analysis
. 2006 Jul 19;2006(3):CD005657.
doi: 10.1002/14651858.CD005657.pub2.

Topical analgesia for acute otitis media

R Foxlee  1 , A Johansson, J Wejfalk, J Dawkins, L Dooley, C Del Mar
Affiliations
Meta-Analysis

Topical analgesia for acute otitis media

R Foxlee et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute otitis media (AOM) is a spontaneously remitting disease for which pain is the most distressing symptom. Antibiotics are now known to have less benefit than previously assumed.

Objectives: To assess the effectiveness of topical analgesia for AOM.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May Week 3 2006), EMBASE (1990 to December 2005) and LILACS (1982 to September 2005) without language restriction, and the reference lists of articles. We also contacted manufacturers and authors.

Selection criteria: Double-blind randomised or quasi-randomised controlled trials comparing an otic preparation with an analgesic effect (excluding antibiotics) versus placebo or an otic preparation with an analgesic effect (excluding antibiotics) versus any other otic preparation with an analgesic effect, in adults or children presenting at primary care settings with AOM without perforation.

Data collection and analysis: Potential studies were screened independently and trial quality was assessed by three authors, and differences were resolved by discussion. Data was then independently extracted from the trials selected by two authors. We contacted the authors of three trials to acquire additional information not available in published articles.

Main results: Our searches yielded 356 records; four trials met our criteria. One trial with 54 participants compared treatment with anaesthetic ear drops versus an olive oil placebo immediately at diagnosis. All patients were also given paracetamol. There was a statistically significant pain reduction of 25% in those receiving anaesthetic drops 30 minutes after instillation. Three trials (with one common co-author) compared anaesthetic ear drops with naturopathic herbal ear drops in 274 patients. One of these trials also used antibiotics in both groups. There were statistically significant differences at instillation of drops, or 15 or 30 minutes after the instillation (or both) on one to three days after diagnosis, always favouring the naturopathic group in each trial.

Authors' conclusions: The evidence from these four randomised controlled trials, only one of which addresses the most relevant question of primary effectiveness, is insufficient to know whether ear drops are effective or not.

PubMed Disclaimer

Conflict of interest statement

One of the co‐authors, Prof Chris Del Mar, acted briefly as a consultant for Key Pharmaceuticals. This Australian‐based company is the manufacturer of the otic solution Ear Clear for Ear Ache Relief. He evaluated the results of one trial and presented evidence to the Australian Therapeutic Goods Association.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Anaesthetic versus placebo, outcome: 1.1 50% reduction in ear pain.
4
4
Forest plot of comparison: 1 Anaesthetic versus placebo, outcome: 1.2 25% reduction in ear pain.
5
5
6
6
Forest plot of comparison: 2 Anaesthetic versus naturopathic, outcome: 2.1 Mean pain score, day 1.
1.1
1.1. Analysis
Comparison 1 Anaesthetic versus placebo, Outcome 1 50% reduction in ear pain.
1.2
1.2. Analysis
Comparison 1 Anaesthetic versus placebo, Outcome 2 25% reduction in ear pain.
2.1
2.1. Analysis
Comparison 2 Anaesthetic versus naturopathic, Outcome 1 Mean pain score, day 1.
2.2
2.2. Analysis
Comparison 2 Anaesthetic versus naturopathic, Outcome 2 Mean pain score, day 2.
2.3
2.3. Analysis
Comparison 2 Anaesthetic versus naturopathic, Outcome 3 Mean pain score, day 3.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Foxlee 2006
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