Steroids for otitis media with effusion: a systematic review.
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.


METHODS
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.


METHODS
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.


METHODS
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.


RESULTS
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.
Butler
C C
CC
Department of Family Medicine, McMaster University, Faculty of Health Sciences, 1200 Main St W, HSC-2V14, Hamilton, Ontario, Canada L8N 3Z5. cbutler@mcmaster.ca
van Der Voort
J H
JH
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D016017:Odds Ratio; D010034:Otitis Media with Effusion / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013256:Steroids