Table 7.

Treatment.

Author, Year of study, Year of publication, Journal/Conference	Country, Population	Study design	Study Question Population - risk group, age	Treatment method/Study method	Study Question Outcome	Study period	Risk of bias
Dave et al., 2019 Indian J Otolaryngol Head Neck Surg.	Urban Indian	Case series	All ages (n = 90) Tertiary referral centre	Tympanoplasty ± mastoidectomy for CSOM	Graft uptake rate in relation with ET function	2016–2017	High - tertiary hospital based
Miyake et al., 2019 Einstein (Sao Paulo)	Brazil	Controlled Open-label randomized	All ages (n = 80)	Incidence of post- MVTI otorrhoea in patients with no water precaution	Protection should be recommended during the first month after surgery but not further on	July 2013–May 2015	Low - lost to follow up, selection
Toman et al., 2019 Trop Med Infect Dis.	Rural South Africa	Case series	Adults (n = 14)	Antibiotic prescription according to culture results	Culture oriented treatment for better disease control	6 week	High -selection, low numbers
Ramkumar et al., 2018 Am J Audiol.	Rural India - cleft palate patients	Case series	Children and adults (3–35 years)	Identifying and managing middle ear disorders through video-otoscopy and Telemedicine	Directing patients to appropriate therapy using video otoscopy and Telemedicine	13 months	High-selection, low numbers
Zahreddine et al., 2018 Pharm Pract (Granada)	Lebanon	Cross -sectional study	Pharmacists and parents	Assessing the correct use of antibiotics for AOM	Necessary to implement educational campaigns to increase awareness of antibiotic misuse and resistance among pharmacists and patients	June-August 2017	High - selection, small numbers
Kouhi et al., 2018 Ear Nose Throat J	Iran	Randomized controlled	All (n = 59)	Assess the influence of corticosteroids on tympanoplasty outcomes	No effect was found on graft uptake following corticosteroid treatment	2013–2014	High - selection, size
Jacups et al., 2018 J Eval Clin Pract.	Australia Indigenous population	Costing Evaluation	Children	Identifying the least costly model of delivery of ENT surgery	Low-risk ENT surgery from a state funded hospital in remote setting with high use of videoconference technology it the most cost effective	2017	Low risk
Udden et al., 2018 Infect Dis Poverty	Angola	Case series	All (n = 152)	Identification of aerobic pathogens in CSOM	The most common pathogens were Enterococcus spp, Pseudomonas aeruginosa and Proteus spp. Resistance rates to quinolones ranged 6–30% and suggested topical therapy with quinolones should be the mainstay	-	High - selection
Nasrallah et al., 2018 Int J Pediatr Otorhinolarngol	Lebanon	Anonymous survey	Physicians (n = 75)	Assessing physician knowledge of AOM diagnosis, management and treatment	Interventions for improving awareness of clinical guidelines should be taken	2017	High - questionnaire
Johnston et al., 2018 ANZ J Surg	New Zealand	Case series	Maori and non-Maroi children (n = 11941)	Compare incidence and outcomes of children with MVTI	No difference in the post-operative course between Maroi and non-Maroi children	January 1996–June 2016	Low - case series, high number
Yazici et al., 2018 Clin Otolaryngol	Turkey	Case series	Children (n = 50)	Compare QOL using OM6 post MVTI	Improvement in QOL following MVTI	December 2016–April 2017	High - case series, small number
Nshimirimana et al., 2018 Int J Otolaryngol	Rawanda	Cross-sectional	All (n = 109)	Determine factors for delayed care seeking in CSOM treatment	Low knowledge of disease and use of traditional medicine	2017	High - tertiary hospital
Smith et al., 2018 J Laryngol Otol	Cambodia	Case series (n = 124)	All	Measuring tympanic membrane closure rate at six weeks and PTA at three months after local surgeon performed surgery	Local training of surgeons shows high success rate in tympanoplasty results	2016–2017	High - case series
Piltcher et al., 2018 Braz J Otorhinolaryngol	Brazil	Literature review	-	Medical management of AOM	Periodic revisions on guidelines and recommendations for treatment should be performed	-	Low
Durham et al., 2018 PLoS One	Australia - Aboriginal and Torres Strait Islander	Online survey and face to face or phone interview	Documents (n = 20) Interview (n = 27)	Driving sustained improvement in OM care in children	A holistic systemic approach is needed for OM care improvement	-	High - interview, survey
Master et al., 2018 Otolaryngol Clin North Am.	Developing countries	Overview	-	Seeking the difficulties in treating CSOM	Surgical management may be warranted and training of local surgeons is required	-	High
Jones et al., 2018 BMC Pediatr	Australia - Indigenous population	In depth semi-structured interviews (n = 21)	Children 0–3 years	Assessing the LiTTLE Program effect on Aboriginal community health	Positive views about the LiTTLe Program possible areas of improvement		High - interviews
Buyukcam et al., 2018 Int J Pediatr Otorhinolaryngol	Turkey	Questionnaire (n = 977)	Paediatricians	Assess paediatricians’ attitude toward AOM treatment and pain management	Educational interventional strategies are needed to improve compliance with EBG for AOM treatment and management, watchful waiting should be applied when appropriate	January 2015-December 2016	High - interviews, university hospital and research hospital paediatricians
Kong et al., 2017 J Paediatr Child Health	Australia - Indigenous and non-Indigenous	Review	Children	Identifying children with OME who need simple ENT surgery	Advancing children who meet surgical criteria to surgery		High - review
Hussein et al., 2017 J Laryngol Otol	Egypt	Prospective randomized study	Children 2–11 years of age (n = 290)	Evaluate the effects of oral steroids alone or followed by intranasal steroids versus WW for OM resolution	Oral steroids lead to a quick resolution of OM with no long term benefits. Intranasal steroids non useful		Low - no randomization, not blinded
Kaya et al., 2017 Eur Arch Otorhinolarngol	Turkey	Prospective randomized controlled	All (n = 13)	Compare the audiologic outcomes of the patients who underwent endoscopy on one ear and microscopic tympanoplasty on the other, and to investigate the operative time, graft success, postoperative pain and health status	Endoscopic approach for type 1 tympanoplasty offers shorter surgery time, better health status and lower postoperative pain than microscopic surgery as well as comparable improvement in air-bone gap and graft success	February 2015-September 2016	High -selection, size
Jacups et al., 2017 Int J Pediatr Otorhinolaryngol	Cape York Indigenous children	Case series	Children (n = 16)	Improving accessibility to ENT surgery through usage of private health care facilities	Private health care provided quicker surgical access and well as good post-operative hearing results		High - small case series
Akhtar et al., 2017 Mymensingh Med J	Bangladesh - tertiary center	Cross sectional prospective study	All (n = 117)	Identify the common microorganism involved and the antibiogram of CSOM patients	Staphylococcus aureus and Pseudomonas aeruginosa most common with sensitivity to gentamycin and ciprofloxacin, respectively		High - selection
Khreesha et al., 2017 Int J Pediatr Otorhinolaryngol	Jordan	Survey	Physicians (n = 71)	Assess AOM treatment trends as well as adherence to guidelines	Encouraging awareness of AOM guidelines	-	High - survey
Ababneh et al., 2017 Int Health	Jordan	Prospective cross-sectional	Children	Assessing antibiotic prescription rate for URTI	Broad spectrum antibiotics are prescribed often for AOM and health policy initiatives should be taken to minimize such prescripitions	-	High
Demant et al., 2017 Trials	Greenland	Investigator initiated multicenter, randomized, blinded superiority trial	Children 9–36 months	Detection of a decrease of 2 visits to a health clinic during 2 years	On going	-	Low - selection bias
Sibthorpe et al., 2017 Aust J Prim Health	Australia - Aboriginal and Torres Strait Islanders	Expert Consensus		Detecting evidence based indicators for continuous quality improvement in the prevention and management of OM and its sequelae	Seven evidence - based indicators were developed from electronic health records	-	High - consensus, selection
Sharma et al., 2016 Indian J Otolaryngol Head Neck Surg	India	Case series	-	Evaluate the outcome of type I tympanoplasty ± mastoidectomy for CSOM	Type I tympanoplasty with cortical mastoidectomy had better graft uptake and audiological results then tympanoplasty alone	One and a half years	High - selection, small series
Yousaf et al., 2106 J Auyb Med Coll Abbottabad	Pakistan	Randomized controlled	Children ages 4–12 years (n = 82)	Evaluate laser myringotomy for the resolution of OME	Laser myringotomy is less effective in clearance of mucoid effusion in long standing and recurrent OME	February 2012-January 2015	High - selection, statistics
Singh et al., 2016 J Laryngol Otol	India	Prospective randomised	Adults (n = 100)	Evaluate the success rate of dry and wet temporalis fascia grafts in type I underlay tympanoplasty.	A dry or wet temporalis fascia graft does not influence the outcome of tympanoplasty type I.	-	?
Silveira et al., 2016 Braz J Otorhinolaryngol	Brazil	Randomized controlled	All (n = 40)	Effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia	Bacterial cellulose grafts promoted the closure of the tympanic membrane perforations	-	?
Amer et al., 2016 Int Arch Otorhinolaryngol	Egypt	Case series	Children (n = 42)	Determine the usefulness of adjuvant IT steroids of OME after MVTI	IT steroids is safe we lower incidence of recurrent OME, tympanosclerosis and otorrhea		High - selection, small series
Bin Mohanna et al., 2016 J Ayub Med Coll Abbottabad	Yemen	Cross - sectional with parental questionnaires	Children 1–15 years of age (n = 150)	Identify the bacterial etiologic agents of OM and determine their sensitivity patterns	Bacterial cultures are essential for guiding antibiotic therapy. Bacterial isolates were Staphylococcus aureus and Pseudomonas aeruginosa most common with sensitivity to cefotaxime and azithromycin as well as amoxicillin - clavulanic acid.	January-October 2015	High - selection, tertiary centre
Maile et al., 2015 Trop Med Int Health	Nepal	Case series	All (n = 242)	Assessing the impact of ear disease and the effect of ear surgery on QoL as well as adapt the GHSI and GBI into relevant questionnaires for Nepali patients	Ear disease is associated with reduced QoL while surgical intervention is associated with an improved QoL. It is essential to invest in measures of QoL in developing nations	-	High - selection
Elsayed et al., 2015 Int J Otolaryngol	Questionnaire	Case series	Children < 2 year old (n = 100)	Assess the impact of educational program on the management of children with CSOM	Education of parents leads to a higher percentage of cure in patients with CSOM	September 2013-May 2014	High - recall

AOM - Acute otitis media; ENT - Ear, nose and throat; CSOM - Chronic suppurative otitis media; ET - Eustachian tube; MVTI - myringotomy plus ventilation tube insertion; OM6 - Otitis media 6 -item questionnaire; QOL - Quality of life; PTA - Pure tone audiometry; OM - Otitis media; LiTTLE Program - Learning to Talk, Talking to Learn; EBG - Evidence based guidelines; CHW - Community health worker; URTI - Upper respiratory tract infection; OME - otitis media with effusion; IT - intratympanic; QoL - Quality of life; GHSI - Glasgow Health Status Inventory; GBI - Glasgow Benefit Inventory.