A priori, the level of evidence provided in many of these studies for standard care is robust. Indeed, the use of fetanyl and acetaminophen (in various doses) for postoperative relief of pain following myringotomy and tube insertion placement in pediatric patients is evidenced in both metaanalysis and clinical studies. While there were numerous sampling and variation issues in some of these studies, the proponderence of evidence suggests these drugs will continue to remain standard care for the treatment of pain.
The other main pharmalogical treatemtents examined, Paracetamol and Dirclofenac, were not proven to be equal to standard care; however, the studies testing the efficacy of these drugs were compromised impugning internal and external validity. In order for these treatments to be used with or in addition to standard care, there must be more tests with the clinical “gold standard” in order to be recommend for use.
The main framework for research moving forward, therefore, should focus on how alternative treatments, either in conjunction with present treatments or independently, might provide added benefits for patients while limiting potential side effects. Accupuncture, the only alternative treatment found in the literature, presents potential benefits in the reduction of nausea in patient- however, evidence only suggests its use with pharmaological treatments. However, more clinical studies need to be performed in order to prove the efficacy of the treatment in pain relief, including tests over the long-term.