Repeated recurrences may require tympanocentesis for culture and sensitivity testing. Acetaminophen or acetaminophen plus codeine may be needed to control pain and as antipyretics early in the treatment. Systemic decongestants, ear drops, and topical vasoconstrictors are of no proven benefit. Tympanocentesis or myringotomy may be indicated for severe pain with bulging ear drum. Oral decongestants and antihistamines are used, however, controlled studies have failed to document efficacy.
Persistence requires audiometry, tympanometry, and consideration for PE tubes.
In children, the treatment is the same as for otitis media. Consider erythromycin 500 mg P.O. q 6 hours for 10 days in adults. Admit STAT for I.V. antibiotics and obtain otolaryngology consult for myringotomy for culture and for possible surgery. If perforation is suspected, refer to otolaryngology. Remove foreign body with irrigation if possible.