title: Antihistamines and/or decongestants for otitis media with effusion (OME) in children.
abstract: BACKGROUND
  Otitis media with effusion (OME) is common and may cause hearing loss with associated developmental delay. Treatment remains controversial. The effectiveness of antihistamines, decongestants and antihistamine/decongestant combinations in promoting the resolution of effusions has been assessed by randomized controlled trials.
  
  
  OBJECTIVE
  The objective of this review is to determine whether antihistamine, decongestant, or combination therapy is effective in treating children who present with OME.
  
  
  METHODS
  The Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2006), EMBASE (1974 to 2006), MEDLINE (1951 to 2006) and a gray literature database were searched using a search strategy created by an experienced medical librarian. The date of the last search was March 2006. Reference lists from included studies and relevant reviews were searched by hand; pharmaceutical manufacturers of antihistamines and decongestants and first authors of included studies were contacted to identify other potentially relevant studies.
  
  
  METHODS
  Randomized controlled trials (RCTs) using antihistamines, decongestants or antihistamine/decongestant combinations as treatment for OME in children were selected. We excluded trials that randomized on the basis of acute otitis media (AOM) even though OME was also studied in follow up.
  
  
  METHODS
  Data were extracted from the published reports by two authors independently using standardized data extraction forms and methods. The methodological quality of the included studies was independently assessed by two authors. Dichotomous results were expressed as a relative risk with 95% confidence intervals using a fixed-effect model when homogeneous and a random-effects model when heterogeneous. Nearly all outcomes analysed were homogeneous. Continuous results were discussed qualitatively. Statistical analysis was conducted using RevMan software.
  
  
  RESULTS
  No statistical or clinical benefit was found for any of the interventions or outcomes studied. However, treated study subjects experienced 11% more side effects than untreated subjects (number needed to treat to harm = 9).
  
  
  CONCLUSIONS
  Because the pooled data demonstrate no benefit and some harm from the use of antihistamines or decongestants alone or in combination in the management of OME, we recommend against their use.
authors.affiliation: Quinte West Medical Centre, 80 Catherine Street, Trenton, Ontario, Canada. ghgriffin@hotmail.com
authors.forename: G H
authors.initials: GH
authors.lastname: Griffin
authors.forename: C
authors.initials: C
authors.lastname: Flynn
authors.forename: R E
authors.initials: RE
authors.lastname: Bailey
authors.forename: J K
authors.initials: JK
authors.lastname: Schultz
mesh_terms: D002648:Child; D004359:Drug Therapy, Combination; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D014663:Nasal Decongestants / Q000009:adverse effects / Q000627:therapeutic use*; D010034:Otitis Media with Effusion / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D006634:Histamine H1 Antagonists; D014663:Nasal Decongestants