A Systematic Review of Management of Otitis Media with Effusion in Children

Abstract

Aim: Otitis media with effusion in children can result in impairment of speech and language development secondary to the effects of conductive hearing loss from the disease. The review was conducted as part of a clinical practice guideline to assist healthcare providers in the management of this condition. Study Design: Systematic review. Place and Duration of Study: Development Group on Otitis Media with Effusion in Children Clinical Practice Guidelines, Medical Development Division, Ministry of Health Malaysia, between 17 August 2010 and 21 February 2012 Methodology: Literature search was carried out on multiple electronic databases. In addition, the reference lists of all retrieved articles were searched to identify relevant studies. Experts in the field were also contacted to identify further studies. All searches were officially conducted between 17 August 2010 and 21 February 2012. All literature retrieved was appraised using Critical Appraisal Skills Programme (Oxford) by at least two members and presented in the form of evidence tables and discussed during development group meetings. The articles used in this review were graded using the US/Canadian Preventive Services Task Force Level of Evidence [7]. Results: A total of 356 relevant titles were identified and 147 abstracts were screened Thirty one articles were used in the results. There was good evidence for non surgical intervention as the initial mode of management. It consists of active observation and medical therapy. Short term (less than six weeks) intranasal steroid can be used for otitis media with effusion (OME) with concurrent allergic rhinitis and adenoid hypertrophy (p<0.001). There was good evidence that oral steroids, prolonged intranasal steroids, antibiotics, antihistamines or decongestants, auto inflation, homeopathy and mucolytics are not beneficial. Surgical intervention should be considered after three months of persistent otitis media with effusion with in children with hearing loss >25 dB (at three frequency average). Myringotomy with ventilation tube (VT) insertion is the procedure of choice. Combined adenoidectomy should be considered in children with persistent OME and hypertrophied adenoids (p<0.001). Conclusion: The initial management of OME in children consists of active observation. Short term (up to 6 weeks) use of intranasal steroids can be used in children with concurrent adenoid hypertrophy or allergic rhinitis. Surgical management is considered after three months of persistent OME. Myringotomy with VT insertion is the procedure of choice.