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Steroids for Otitis Media With Effusion
A Systematic Review
Christopher C. Butler, BA, MB, ChB, DCh, MRCGP, CCH, MD;
Judith H. van der Voort, MRCP
Arch Pediatr Adolesc Med. 2001;155:641-647.
Background Otitis media with effusion (OME) is common and may cause hearing loss
with associated delayed language development in children. Treatment remains
controversial.
Objective To examine evidence for or against treating OME with systemic or topical
nasal steroids.
Data Sources We searched the Cochrane Controlled Trials Register using the terms otitis media; otitis media with effusion; glue ear; or OME and steroids; glucocorticoids; glucocorticoids, synthetic; glucocorticoids, topical; or anti-inflammatory agents, steroidal; or various combinations
of these terms. EMBASE and MEDLINE were also searched.
Study Selection Randomized controlled trials of oral and topical nasal steroids, either
alone or in combination with another agent such as an antibiotic, were included.
Ten studies met the inclusion criteria.
Data Extraction Data extraction and methodological quality assessment were performed
by the 2 of us (C.C.B. and J.H.v.d.V.) independently, using standardized methods
described in the Cochrane Collaboration Handbook.
Data Synthesis The odds ratio for OME persisting after short-term follow-up in children
treated with oral steroids compared with a control was 0.22 (95% confidence
interval, 0.08 = 0.63), and was 0.32 (95% confidence interval, 0.20 = 0.52)
for children treated with oral steroids plus an antibiotic compared with a
control plus an antibiotic. Trends favored steroids for most other comparisons,
but confidence intervals included unity. Trends favored steroids for most
other comparisons, but confidence intervals included unity.
Conclusions Steroids alone or combined with an antibiotic lead to a quicker resolution
of OME in the short-term. However, there is no evidence for a long-term benefit
from treating hearing loss associated with OME with either oral or topical
nasal steroids. These treatments are, therefore, not recommended.
From the Departments of Family Medicine (Dr Butler) and Pediatrics
(Dr van der Voort), McMaster University Medical Centre, Hamilton, Ontario.
Corresponding author: Christopher C. Butler, BA, MB, ChB, DCh, MRCGP,
CCH, MD, Department of Family Medicine, McMaster University, Faculty of Health
Sciences, 1200 Main St W, HSC–2V14, Hamilton, Ontario, Canada L8N 3Z5
(e-mail: cbutler{at}mcmaster.ca).
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