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Otitis Media With Effusion: Comparative Effectiveness of Treatments
Comparative Effectiveness Reviews, No. 101
Investigators: Nancy D Berkman, PhD, Ina F Wallace, PhD, Michael J Steiner, MD, Melody Harrison, PhD, CCC-SLP, Amy M Greenblatt, BA, Kathleen N Lohr, PhD, Adam Kimple, MD, and Andrea Yuen, BS.
Author Information and AffiliationsStructured Abstract
Objectives:
To compare benefits and harms of strategies currently in use for managing otitis media with effusion (OME). Treatment for OME may include single approaches alone or combinations of two or more approaches. We compared benefits and harms among these treatments: tympanostomy tubes (TT), myringotomy (myr), adenoidectomy (adenoid), autoinflation (auto), oral or nasal steroids, complementary and alternative medicine (CAM), and watchful waiting (WW). We included comparisons of treatment effectiveness in subgroups of patients with OME, and whether outcome differences were related to factors affecting health care delivery or the receipt of pneumococcal vaccine inoculation.
Data sources:
We identified five recent systematic reviews a priori and searched MEDLINE,® Embase,® the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®), from root through August 13, 2012, for additional studies. Eligible studies included randomized controlled trials (RCTs), nonrandomized trials, and cohort studies.
Review methods:
Eligible studies included at least two arms comparing the treatments described above. Pairs of reviewers independently selected, extracted data from, and rated the risk of bias of relevant studies; they graded the strength of evidence using established criteria. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively.
Results:
We identified 59 studies through the earlier reviews and our independent searches. Generally, studies examined interventions in otherwise healthy, noninfant children. We did not find any eligible studies covering CAM. Findings are reported for clinical and functional outcomes, and harms. Variation in length of TT retention corresponded to whether TT were designed to be short versus long term, but variation in TT type was not related to improved OME and hearing outcomes. TT decreased OME for 2 years compared with WW or myr, and improved hearing for 6 months compared with WW. OME resolution was more likely with adenoid than no treatment at 12 months. Adenoid and myr were superior to myr alone in relation to OME and hearing outcomes at 24 months. Adenoid and TT were superior to WW for hearing outcomes at 24 months. Auto was superior to standard treatment at improving OME at 1 month. We found no benefits from oral steroids at 2 months, or topical steroids at 9 months. In relation to functional outcomes, TT and WW did not differ in long-term language, cognitive or academic outcomes. Tympanosclerosis and otorrhea were more common in ears with TT. Adenoid increased the risk of postsurgical hemorrhage. In one study of a subgroup, adults receiving auto were more likely to recover from OME than those in the control group at one month. We found no studies examining the influence of any health care factors on treatment effectiveness.
Conclusions:
There is evidence that both TT and adenoid reduce OME and improve hearing in the short term, but both treatments also have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring AOM recurrence, functional outcomes, quality of life measures, and long-term outcomes. Finally, additional research is needed to support treatment decisions in subpopulations, particularly those with comorbidities and those who have received a pneumococcal vaccine inoculation.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Introduction
- Results of Literature Searches
- KQ 1 Comparative Effectiveness of Interventions: Clinical Outcomes or Health Care Utilization
- KQ 2 Comparative Effectiveness of Interventions: Functional and Quality-of-Life Outcomes
- KQ 3 Harms or Tolerability
- KQ 4 Comparative Effectiveness of Interventions for Subgroups of Patients
- KQ 5 Comparative Effectiveness by Health Care Factors
- Discussion
- References
- Appendix A Search Strategy
- Appendix B Excluded Studies
- Appendix C Evidence Tables
- Appendix D Abstract and Full-Text Forms
- Appendix E Risk-of-Bias Tables
- Appendix F Detailed Strength of Evidence Tables
- Appendix G Glossary
- Appendix H Acronyms
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10056-I, Prepared by: RTI-UNC Evidence-based Practice Center, Research Triangle Park, NC
Suggested citation:
Berkman ND, Wallace IF, Steiner MJ, Harrison M, Greenblatt AM, Lohr KN, Kimple A, Yuen A. Otitis Media With Effusion: Comparative Effectiveness of Treatments. Comparative Effectiveness Review No. 101. (Prepared by the RTI-UNC Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 13-EHC091-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Research Triangle Institute-University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10056-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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