A new AHRQ research review compares the benefits and potential harms of treatments for otitis media with effusion (OME)—a collection of fluid in the middle ear without signs or symptoms of acute ear infection. The review finds evidence that placement of tympanostomy tubes and removal of the adenoids (adenoidectomy), both alone or in combination, decrease the time with OME and improve hearing in the short term—up to 2 years in relation to OME and up to 1 year in relation to hearing. However, the evidence did not show differences in longer term speech, language, or other functional outcomes.
The review further finds that results were mixed concerning whether there is additional benefit from both placement of tympanostomy tubes and an adenoidectomy, and there is evidence of potential harms associated with each. Drainage from the ear is common after placement of tympanostomy tubes and can be persistent; post-surgical hemorrhage, although rare, can result from adenoidectomy. Consistent with current guidelines, newer evidence did not show that nasal or oral steroids provide any benefit.
According to the review, large, well-controlled studies using a common protocol could help resolve the risk-benefit ratio of treating OME by measuring the recurrence of acute otitis media, quality-of-life measures, and functional and other long-term outcomes. The studies reviewed were limited largely to children without other medical problems.
Additional research is needed to support treatment decisions in subpopulations, including adults, children with coexisting conditions such as craniofacial abnormalities or Down syndrome, and children who have received pneumococcal vaccination, which is associated with a reduced risk of acute otitis media.
OME occurs commonly during childhood, with as many as 90 percent of children (80% of individual ears) having at least one episode of OME by age 10. In the United States, treatment for OME is estimated to total approximately $4 billion per year. These findings are available in the research review, Otitis Media With Effusion: Comparative Effectiveness of Treatments. You can access the review at: http://go.usa.gov/TzpQ.