UMEM Educational Pearls

Category: Pediatrics

Title: Topical Lidocaine for AOM

Keywords: Acute Otitis Media, Topical Lidocaine, Wait and See, Analagesia (PubMed Search)

Posted: 5/9/2008 by Sean Fox, MD (Updated: 4/24/2024)
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Topical Lidocaine for Acute Otitis Media

  • Up to 83% of children with have AOM at least once by their 3rd birthday.
  • In 2006, the AAP supported a “wait-and-see” plan for antibiotic prescription
    • Who can you withhold abx on?
      • Older than 6months
      • No severe infections (T>39°C)
      • If yes to both, may hold Abx for 48 hours.
  • This approach does not mean “No treatment.”  Pain management is imperative.
    • Oral Analgesics are recommended in all cases.
    • Topical aqueous 2% licocaine eardrops also provide Rapid Pain Relief
      • Randomized, double-blinded, placebo-control study of topical lidocaine vs. placebo (water) demonstrated decreased pain scores at 10, 20, and 30 minutes after administration.
      • These can also be used safely at home for a few days.


Spiro, D. Tay, K. Wait-to-see prescription for the treatment of acute otitis media. JAMA 2006, 1235.

Bolt, P., Barnett, P., Babl, F., Sharwood, L. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008; 93: 40-44.