Summary of findings for the main comparison. Topical antiseptic compared to no treatment for chronic suppurative otitis media.
| Topical antiseptic compared to no treatment for chronic suppurative otitis media | |||||||
| Patient or population: chronic suppurative otitis media Setting: community setting, Malawi Intervention: topical antiseptic (boric acid in alcohol ear drops and daily dry mopping) Comparison: no topical antiseptic (daily dry mopping alone) | |||||||
| Outcomes | Number of participants (studies) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | Certainty of the evidence (GRADE) | What happens | ||
| Without topical antiseptic | With topical antiseptic | Difference | |||||
| Resolution of ear discharge (between 1 week and up to 2 weeks) ‐ not reported | — | — | — | — | — | — | No study reported this outcome at this time point |
| Resolution of ear discharge (4 weeks or more) Follow‐up: 3 to 4 months |
180 (1 RCT) |
RR 1.73 (1.21 to 2.47) | Study population | ⊕⊝⊝⊝ very low1 | Boric acid in alcohol ear drops with dry mopping may help resolve ear discharge at 3 to 4 months, compared with dry mopping alone, but we are very uncertain | ||
| 31.5% | 54.5% (38.1 to 77.9) | 23.0% more (6.6 more to 46.3 more) | |||||
| Health‐related quality of life ‐ not reported | — | — | — | — | — | — | No study reported this outcome |
| Ear pain (otalgia) or discomfort or local irritation ‐ not reported | — | — | — | — | — | — | No study reported this outcome |
| Hearing Follow‐up: 4 months | 180 (1 RCT) |
One study stated that "there was no deterioration of hearing in groups 2 [boric acid] ... as compared to group 1 [no additional treatment]." | very low2 | We are very uncertain whether hearing is improved when boric acid in alcohol is used with dry mopping | |||
| Serious complications ‐ not reported | — | — | — | — | — | — | No study reported that any participant died or had any intracranial or extracranial complications |
| Suspected ototoxicity | 180 (1 RCT) |
One study stated that "there was no deterioration of hearing in groups 2 [boric acid] ...as compared to group 1 [no additional treatment]. Thus, no signs of ototoxicity could be found." | very low3 | — | |||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio | |||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||||
1Downgraded to very low‐certainty: downgraded by two levels due to study limitations (risk of bias) because of concerns about randomisation, blinding, attrition bias and selective reporting. Downgraded by one level due to imprecision as there was one small study (180 participants) with a confidence interval crossing the line of minimally important benefit.
2Downgraded to very low‐certainty: downgraded by two levels due to study limitations (risk of bias) because of concerns about randomisation, blinding, attrition bias and selective reporting. Downgraded by one level due to imprecision as numeric results were not presented for this outcome.
3Downgraded to very low‐certainty: downgraded by two levels due to study limitations (risk of bias) because of concerns about randomisation, blinding, attrition bias and selective reporting. Downgraded by one level due to indirectness of the outcome: only hearing appears to have been considered for the outcome of ototoxicity and not other factors such as tinnitus or balance problems. Downgraded by one level due to imprecision, as numeric results were not presented for this outcome.