Effect of topical adrenergic decongestants on middle ear pressure in infants with common colds

Background Otitis media is frequently a complication of the common cold. Obstruction of the eustachian tube ostia by nasopharyngeal edema has been suggested as a cause of this complication. Objective To determine the effect of a topical adrenergic decongestant on middle ear pressure in infants with common cold symptoms. Methods The study was conducted with a randomized, double blinded, placebo-controlled design. Middle ear pressure was determined in infants 6 to 18 months old who had common cold symptoms. Infants with abnormal middle ear pressure (≤-100 mm H2O) in either ear were treated with intranasal phenylephrine drops or placebo. The effect of the treatment on middle ear pressure in ears with abnormal pressure at baseline was determined 1 h later. Results Twenty-three of 44 infants with abnormal middle ear pressures received intranasal phenylephrine drops and 21 received placebo. Middle ear pressure remained abnormal after treatment with phenylephrine in 29 of 33 (88%) ears and after treatment with placebo in 26 of 34 (76%). The mean change in middle ear pressure after treatment was +23 mm H2O in the active group and +40 mm H2O in the placebo group. Conclusions Treatment of nasal obstruction with topical adrenergic decongestants does not improve abnormal middle ear pressures during the common cold.