Other medical modalities recommended for the treatment of otitis include corticosteroids, administered orally or intra nasally;33-36 antihistamines; and/or decongestants. Although there is evidence that orally administered corticosteroids may help clear chronic middle ear effusion, there is no evidence that this provides a long-term benefit in patients with chronic otitis media with effusion.35 In addition, there is the risk of potential side effects from utilization of cortocosteroids. Intranasal steroids may play a role in patients with chronic middle ear effu-sion.36 However, there is no evidence of efficacy in the treatment of acute otitis media. Antihistamine/decongestant preparations have been used in the past for treatment of otitis media with effusion. However, there is no evidence that this accelerates clearance of middle ear effusion and there appears to be no role for these medications in the treatment of acute otitis media.37 In children who have significant symptoms of nasal congestion and rhinorrhea related to upper respiratory tract infection or allergic rhinitis, there may be a role for these preparations. In older patients with a history of recurrent otitis media of chronic otitis media with effusion when there is symptomatology or family history suggestive of inhalant allergies, an allergy evaluation should be recommended. In addition, there is evidence that second-hand smoke exposure may be an etio-logic factor in chronic otitis media in children,38'39 and this should be addressed by parental education, to decrease the patient's exposure.
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