Surgical prevention of otitis media.
Increasing concerns over drug-resistant bacteria mandate that alternative methods of treatment and prevention, including surgery, be considered to reduce antibiotic usage for acute otitis media (AOM). Meta-analysis of five randomized trials of tubes versus no surgery showed a mean absolute decrease in AOM incidence of 1.0 episode per child-year (95% CI, 0.4-1.6), with a relative decrease of 56%. Similarly, the prevalence of middle-ear effusion decreased by 115 days per child-year (95% CI, 11-220). Within several weeks of tube placement 79% of children had improved quality of life, 17% had trivial change, and 4% were worse. Systematic review of 134 articles revealed transient post-operative otorrhea in 16% of patients with tubes, and later in 26%; recurrent otorrhea occurred in 7.4% of patients and chronic otorrhea in 3.8% Adenoidectomy reduced AOM incidence by 0.32 episodes per child-year (95% CI, 0.03-0.61) for a 3-year period in one study (26% relative decrease), but the effect was only significant for children with prior tubes. Surgical therapy of otitis media offers significant benefits and is an effective prevention strategy in selected children.
Rosenfeld
R M
RM
Department of Otolaryngology, SUNY Health Science Center at Brooklyn, 339 Hicks Street, Brooklyn, NY 11201, USA. richrosenfeld@msn.com
D000233:Adenoidectomy; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008876:Middle Ear Ventilation; D015337:Multicenter Studies as Topic; D010033:Otitis Media / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D014068:Tonsillectomy; D016896:Treatment Outcome