Otitis media with effusion in children

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Otitis media with effusion (OME) is an accumulation of fluid in the middle ear without symptoms or signs of acute inflammation. It is a very common presentation in children in primary care, and has a wide spectrum of impact in terms of effects on hearing, speech, general health, and development.

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Focus of the review

This overview is important as it evaluates a range of treatments that are frequently applied or mis-applied during watchful waiting for the condition, and also evaluates surgery itself. OME remains one of the most common reasons for surgery in children in the developed world.

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Comments on evidence

Most clinical trials have examined effectiveness in secondary care settings, which feature prominently in this overview, whereas the majority of children are seen in the community. Evidence is emerging for non-surgical interventions, and this evidence needs to be considered alongside the more established surgical treatments. Child-centred and quality of life measures also need greater consideration as outcomes.

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Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, March 2010, to January 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 30 studies and the further review of 21 full publications. Of the 21 full articles evaluated, three systematic reviews were updated and two systematic reviews and one RCT were added at this update.

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Substantive changes at this update

Antibiotics (oral) One new systematic review added.[14] One systematic review updated.[15] Categorisation changed from 'unlikely to be beneficial' to 'likely to be ineffective or harmful'.

Corticosteroids (oral) One systematic review updated.[15] Categorisation changed from 'trade-off between benefits and harms' to 'unknown effectiveness'.

Corticosteroids (intranasal) One systematic review updated.[15] Categorisation unchanged (unlikely to be beneficial).

Auto-inflation using purpose-manufactured devices One systematic review updated.[28] Categorisation changed from 'unknown effectiveness' to 'likely to be beneficial'.

Auto-inflation using non-purpose-manufactured devices One systematic review updated.[28] Categorisation unchanged (unknown effectiveness).

Ventilation tubes One systematic review updated[36] and one RCT added.[37] Categorisation unchanged (trade-off between benefits and harms).

Ventilation tubes plus adenoidectomy One systematic review updated[36] and one added.[40] Categorisation unchanged (trade-off between benefits and harms).

Abstract

INTRODUCTION: Up to 80% of children have been affected by otitis media with effusion (OME) by the age of 4 years, but prevalence declines beyond 6 years of age. Non-purulent middle-ear infections can occur in children or adults after upper respiratory tract infection or acute otitis media. Half or more of cases resolve within 3 months and 95% within 1 year, but complications such as tympanic membrane perforation, tympanosclerosis, otorrhoea, and cholesteatoma can occur. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of pharmacological interventions to treat OME in children? What are the effects of mechanical device interventions to treat OME in children? What are the effects of surgical interventions to treat OME in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, after deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 30 studies and the further review of 21 full publications. Of the 21 full articles evaluated, three systematic reviews were updated and two systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for 13 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for eight interventions based on information about the effectiveness and safety of adenoidectomy, antibiotics, auto-inflation (using both purpose-manufactured devices and non-purpose-manufactured devices), intranasal corticosteroids, oral corticosteroids, ventilation tubes, and ventilation tubes plus adenoidectomy.

Cite as

Williamson I. Otitis media with effusion in children. Systematic review 502. BMJ Clinical Evidence. . 2015 November. Accessed [date].

Latest citations

Antibiotics for otitis media with effusion in children. ( 06 July 2016 )

Adenoidectomy with or without grommets for children with otitis media: an individual patient data meta-analysis. ( 13 January 2016 )