Table 4.
Treatment effects of interventions for otitis media in children that have been assessed in randomized, controlled trials
| Intervention | Evidence | Effect |
|---|---|---|
| Prevention | ||
| Conjugate pneumococcal vaccine | Three studies (39,749 participants) | Acute otitis media episodes reduced by 6% (eg, from 1.0 to 0.94 episodes per year); insertion of tympanostomy tubes reduced from 3.8% to 2.9% |
| Influenza vaccine | 11 studies (11,349 participants) | Inconsistent results; modest protection against otitis media during influenza season in some studies |
| Treatment of initial acute otitis media | ||
| Antihistamines and decongestants | 12 studies (2300 participants) | No significant difference in persistent acute otitis media at 2 weeks |
| Antibiotics | Eight studies (2287 participants) | Persistent pain on day 2 through 7 reduced from 22% to 16% |
| Six studies (1643 participants) | Persistent reduced from 55% to 30% in children younger than 2 years old who had with bilateral acute otitis media and from 53% to 19% in children who had acute otitis media with perforation | |
| Myringotomy | Three studies (812 participants) | Early treatment failure increased from 5% to 20% |
| Analgesics | One study (219 participants) | Persistent pain reduced from 25% to 9% on day 2 |
| Treatment of recurrent acute otitis media | ||
| Antibiotics | 16 studies (1483 participants) | Episodes of acute otitis media reduced from 3.0 to 1.5 episodes per year |
| Adenoidectomy | Six studies (1,060 participants) | No significant reduction in rates of acute otitis media |
| Tympanostomy tubes | Five studies (424 participants) | Episodes of acute otitis media reduced from 2.0 to 1.0 episodes per year |
| Treatment of persistent otitis media with effusion | ||
| Antibiotics | Nine studies (1534 participants) | Persistent otitis media with effusion at around 4 weeks reduced from 81% to 68% |
| Tympanostomy tubes | 11 studies (∼1300 participants) | Modest improvement in hearing (9 dB at 6 months and 6 dB at 12 months); no improvement in language or cognitive assessment |
| Antihistamines and decongestants | Seven studies (1177 participants) | No difference in persistent otitis media with effusion at 4 weeks (75%) |
| Autoinflation | Six studies (602 participants) | Inconsistent results; modest improvement in tympanometry at 4 weeks in some studies |
| Antibiotics plus steroids | Five studies (418 participants) | Persistent otitis media with effusion at 2 weeks reduced from 75% to 52% |
| Treatment of chronic suppurative otitis media | ||
| Topical antibiotics | Seven studies (1074 participants) | Persistent chronic suppurative otitis media at 2 to 16 weeks reduced from around 75% to 20% to 50% |
| Ear cleaning | Two studies (658 participants) | Inconsistent results; no reduction in persistent chronic suppurative otitis media at 12 to 16 weeks (78%) in a large African study |