Table 3.
Treatment effects of interventions for otitis media in children who have been assessed in randomized controlled trials
| Intervention | Evidence | Effect (no Intervention vs Intervention) |
|---|---|---|
| Prevention | ||
| Pneumococcal conjugate vaccine11 | 3 studies (39,749 participants) |
Acute otitis media episodes reduced by 6% (eg, 1.0 vs 0.94 episodes per year). Insertion of tympanostomy tubes reduced (3.8% vs 2.9%) |
| Influenza vaccine12, 13 | 11 studies (11,349 participants) |
Inconsistent results. Modest protection against otitis media during influenza season in some studies |
| Treatment of persistent otitis media with effusion | ||
| Antibiotics14, 15 | 9 studies (1534 participants) |
Persistent OME at around 4 weeks reduced (81% vs 68%) |
| Tympanostomy tubes16, 17 | 11 studies (∼1300 participants) |
Modest improvement in hearing: 9dB at 6 mo and 6dB at 12 mo. No improvement in language or cognitive assessment |
| Antihistamines and decongestants18 | 7 studies (1177 participants) |
No difference in persistent OME at 4 wk (75%) |
| Autoinflation19 | 6 studies (602 participants) |
Inconsistent results. Modest improvement in tympanometry at 4 wk in some studies |
| Antibiotics plus steroids20 |
5 studies (418 participants) |
Persistent OME at 2 wk reduced (75% vs 52%) |
| Treatment of initial acute otitis media | ||
| Antihistamines and decongestants21 | 12 studies (2300 participants) |
No significant difference in persistent AOM at 2 wk |
| Antibiotics22, 23 | 8 studies (2287 participants) 6 studies (1643 participants) |
Persistent pain on day 2–7 reduced (22% vs 16%) Persistent AOM reduced in children <2 y old with bilateral AOM (55% vs 30%) and in children with AOM with perforation (53% vs 19%) |
| Myringotomy24 | 3 studies (812 participants) |
Early treatment failure increased (5% vs 20%). |
| Analgesics25 | 1 study (219 participants) |
Persistent pain reduced on day 2 (25% vs 9%). |
| Treatment of recurrent acute otitis media | ||
| Antibiotics26 | 16 studies (1483 participants) |
Acute otitis media episodes reduced (3.0 vs 1.5 episodes per year) |
| Adenoidectomy27, 28, 29 | 6 studies (1060 participants) |
No significant reduction in rates of AOM |
| Tympanostomy tubes27, 30 | 5 studies (424 participants) |
Acute otitis media episodes reduced (2.0 vs 1.0 episodes per year) |
| Treatment of chronic suppurative otitis media | ||
| Topical antibiotics31, 32, 33 | 7 studies (1074 participants) |
Persistent CSOM at 2–16 wk reduced (around 75% vs 20%–50% |
| Ear cleaning31, 34 | 2 studies (658 participants) |
Inconsistent results. No reduction in persistent CSOM at 12–16 wk (78%) in large African study |