Study of middle ear disease using tympanometry in general practice.

Reves, Randall; Budgett, R; Miller, Deborah E.; Wadsworth, Judy; Haines, Andy

doi:10.1136/bmj.290.6486.1953

Cited by 9 publications

(2 citation statements)

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“…Review and screening of initial articles plus manual crosschecks identified 63 source articles that met inclusion criteria and had extractable data. The source articles included 11 RCTs of AOM antibiotic versus placebo or no drug, 30–40 1 RCT of AOM homeopathy versus placebo, 41 9 cohort studies of restrictive antibiotics for AOM, 42–50 14 RCTs of recurrent AOM antimicrobial prophylaxis versus placebo or no drug, 51–64 1 cohort study of recurrent AOM natural history, 65 18 cohort studies of OME natural history, 66–83 2 RCT enrollment cohorts of OME therapy, 84,85 and 7 cohorts or RCT control groups of chronic OME natural history 86–92 …”

Section: Resultsmentioning

confidence: 99%

Natural history of untreated otitis media

2003

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ObjectivelHypothesis:Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media (AOM) and otitis media with effision (OME). Study D e s i p Systematic literature review and meta-analysis. Method Source articles were identified by MEDLINE search through August 2002 plus manual crosschecks of bibliographies and published meta-analyses. Data were abstracted independently by two investigators and combined with random effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity analysis was performed. Results: Sixty-three articles met inclusion criteria AOM symptoms improved within 24 hours without antibiotics in 61% of children (95% CI, 50-72%), rising to 80% by 2 to 3 days (95% CI, 69-%).Suppurative complications were comparable if antibiotics were withheld (0.12%) or provided (0.24%). Children entered recurrent AOM trials with a mean rate of 5.5 or more annual episodes but averaged only 2.8 annual episodes while on placebo (95% CI, 2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI, 50-68%) and 74% resolution by 3 months (95% CI, 68-SO%). OME of unknown duration had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6 months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6 months and 33% resolution by 1 year. Conclusions: The natural history of otitis media is very favorable. Combined estimates of spontaneous resolution provide a benchmark against which to judge new or established interventions. The need for surgery in children with recurrent AOM or chronic OME should be balanced against the likelihood of timely spontaneous resolution and the potential risk of learning, language, or other adverse se-

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Section: Resultsmentioning

confidence: 99%

Natural history of untreated otitis media

2003

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“…These areas should be regarded as extensions of the clinical laboratory, and it must be made perfectly clear who is responsible for the apparatus and for training and supervising the staff using it. 9 The further extension of side room testing to community based clinics and general practitioners' surgeries implies that the dangers of infection from biological specimens need to be widely known. It also needs to be made clear who is responsible-and thus answerable for accidents-in these settings.…”

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confidence: 99%