title: Pain management in young children undergoing diagnostic tympanocentesis.
abstract: OBJECTIVE
  To describe the pain associated with diagnostic tympanocentesis and to gather preliminary data comparing the efficacy of 3 methods of pain reduction for tympanocentesis.
  
  
  METHODS
  In children 6 to 36 months of age undergoing tympanocentesis for acute otitis media, the authors measured pain and distress throughout all phases of the procedure and recovery using physiological (heart rate) and behavioral measures (cry duration, Global Mood Scale score, and pain visual analog scales). They compared--in a randomized controlled trial--3 pain reduction interventions: acetaminophen, acetaminophen plus codeine, and ibuprofen plus midazolam.
  
  
  RESULTS
  Heart rate increased throughout the procedure, peaking during needle aspiration. Children treated with acetaminophen alone had higher peak heart rates and Global Mood Scale scores during parts of the procedure.
  
  
  CONCLUSIONS
  Acetaminophen alone may not be as effective in reducing pain-related physiological and behavioral changes as acetaminophen plus codeine or ibuprofen plus midazolam during diagnostic tympanocentesis.
authors.affiliation: University of Pittsburgh School of Medicine, and General Academic Pediatrics, Children's Hospital of Pittsburgh, 3414 Fifth Ave., Pittsburgh, PA 15213, USA. nader.shaikh@chp.edu
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
authors.forename: Marcia
authors.initials: M
authors.lastname: Kurs-Lasky
authors.forename: Howard E
authors.initials: HE
authors.lastname: Rockette
authors.forename: Anita
authors.initials: A
authors.lastname: Chandra
authors.forename: D Kathleen
authors.initials: DK
authors.lastname: Colborn
authors.forename: Emma G
authors.initials: EG
authors.lastname: Hooper
authors.forename: Evelyn Cohen
authors.initials: EC
authors.lastname: Reis
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000208:Acute Disease; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D044963:Biopsy, Fine-Needle; D002675:Child, Preschool; D003061:Codeine / Q000627:therapeutic use; D003939:Diagnostic Techniques, Otological / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004432:Ear, Middle / Q000473:pathology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007052:Ibuprofen / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D010033:Otitis Media / Q000473:pathology*; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010147:Pain Measurement; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D000082:Acetaminophen; D008874:Midazolam; D003061:Codeine; D007052:Ibuprofen