Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children

Simpson, Sharon Anne; Lewis, Ruth; Voort, Judith van der; Butler, Christopher Collett

doi:10.1002/14651858.cd001935.pub3

Cited by 103 publications

(75 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A Cochrane systematic review, 53 search date August 2010, which included 12 studies and 945 patients, found some evidence for improved short-term resolution of OME in those treated in secondary care with oral steroids, either alone or combined with antibiotics. However, there is insufficient evidence to date to determine their effect on resolution of OME-related symptoms or on longer-term outcomes.…”

Section: The Evidence For Steroidsmentioning

confidence: 99%

“…The systematic review also included several trials, and a UK primary care study of topical intranasal corticosteroids, and concluded that there was sufficient evidence to make the statement that there was 'no benefit from topical intranasal steroids'. 18,53 Oral steroids have, however, been mooted as a simple, cheap treatment with the advantage that they could be used for a wide age range of selected affected children. However, better evidence of their effectiveness in clearing effusions, in improving patient-centred outcomes in the short and longer term, evidence for their cost-effectiveness and, importantly, a comprehensive evaluation of any associated harms is still required.…”

Section: The Evidence For Steroidsmentioning

confidence: 99%

See 1 more Smart Citation

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

Williamson

Vennik

Harnden

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundOtitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment.ObjectiveTo determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children.DesignA pragmatic, two-arm, open randomised controlled trial.SettingForty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013.ParticipantsSchool children aged 4–11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears.InterventionThree hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1–3 months plus usual care, or usual care alone.Main outcome measuresThe proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes.ResultsAt 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference –0.42;p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted.ConclusionWe found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.Trial registrationCurrent Controlled Trials ISRCTN55208702.FundingThis project was funded by the National institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment, Vol. 19, No. 72. See the NIHR Journals Library website for further project information.

show abstract

Section: The Evidence For Steroidsmentioning

confidence: 99%

Section: The Evidence For Steroidsmentioning

confidence: 99%

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

Williamson

Vennik

Harnden

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…13 Unfortunately, all available medical treatments for otitis media with effusion such as antibiotics, antihistamines, decongestants and intranasal steroids are ineffective and have unwanted effects, and therefore cannot be recommended. [21][22][23] Not only are antibiotics ineffective, but resistance to them poses a major threat to public health. 24,25 Although surgery is effective for a carefully selected minority, 13,26,27 a simple low-cost, nonsurgical treatment option could ben-…”

mentioning

confidence: 99%

Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial

Williamson

Vennik

Harnden

et al. 2015

CMAJ

View full text Add to dashboard Cite

show abstract

“…Inthe UnitedStates,surgical treatments are common interventions for persistent or recurrent OME. In contrast, steroids are not recommended in current guidelines, 7 and a recent review did not find them to be effective 8 ; autoinflation is uncommon; and no randomized controlled trials (RCTs) provided evidence concerning complementary and alternative medicine procedures. A recent systematic review of antibiotics did not support routinely treating children diagnosed with OME with antibiotics.…”

mentioning

confidence: 99%

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

et al. 2014

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVE: The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study' s objective was to compare the effectiveness of surgical strategies currently used for managing OME. METHODS:We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. RESULTS:We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage.CONCLUSIONS: Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the riskbenefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.

show abstract

Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children

Cited by 103 publications

References 49 publications

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

Contact Info

Product

Resources

About