Efficacy of Pseudoephedrine and Oxymetazoline in Preventing Otic Barotrauma: A Systematic Review and Meta-Analysis

BACKGROUND: Otic barotrauma (aerotitis media) occurs when the middle-ear pressure fails to equalize during environmental pressure changes (eg, flying, diving, hyperbaric therapy). Oral pseudoephedrine and intranasal oxymetazoline are commonly used prophylactically, but comparative efficacy and the strength of evidence remain uncertain. METHODS: We registered a protocol on PROSPERO (CRD420251089756) and conducted a PRISMA-guided systematic review of randomized controlled trials evaluating oral pseudoephedrine or intranasal oxymetazoline for the prevention of otic barotrauma in adults. RevMan 5.4 was used for meta-analysis. Relative risks (RR) with 95% CI were pooled using a fixed-effect generic inverse-variance model. RESULTS: Four double-blind randomized trials (n=490; conducted 1992-1998) met inclusion. Pseudoephedrine (3 trials) significantly reduced the risk of otic barotrauma versus placebo (RR: 0.55; 95% CI: 0.48-0.66; P