Surgical Treatments for Otitis Media With Effusion: A Systematic Review

Abstract

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.

Prevalence of otitis media with effusion among school age children in rural parts of Konya province, Turkey

“…Guidelines recommend either surgery in the form of ventilation tubes or hearing aids. [8] Complications of SOM occur especially if the disease is not recognized in its early stages and/or treated accordingly. Chronic otitis media, adhesive otitis media, retraction pockets, and tympanosclerosis are the most common complications of chronic SOM and when permanent hearing loss develops due to complications, it may lead to impairment in development of speech and language.…”

Grommets for Otitis Media With Effusion in Children With Cleft Palate: A Systematic Review

“…Although a large number of reviews on the use of surgical treatment for OME in children with cleft palate have been published, many of these were narrative, 3,[8][9][10][11] and others were systematic investigations that pertained mainly to otherwise healthy children with typical developmental characteristics. 6,[12][13][14][15][16][17][18][19][20][21] A lack of research on the subgroup of children with cleft palate means that there is currently no evidence-based information available to clinicians and parents about the effectiveness of grommet insertion to treat OME in children with cleft palate. Only 1 systematic review addressed the early routine insertion of grommets for OME in children with cleft palate.…”

Tympanostomy Tube Placement for Otitis Media with Effusion in Children with Cleft Lip and Palate

“…Despite the fact that a number of reviews have been published on treatment choices for the management of OME in CLP children, a number of these are narrative reviews [3,6,[96][97][98], whereas others are systematic reviews pertaining mainly to otherwise healthy children [27,45,77,95,[99][100][101][102][103][104][105]. The lack of research on the CLP subgroup of children means that there is currently no evidence-based information for clinicians or parents with regard to the effectiveness of grommets for OME in CLP children.…”