Outcomes of Treating Otitis Media With Effusion *
Intervention | Benefits‡ | Harms‡ |
---|---|---|
Observation | Base case | Base case |
Antibiotics | Improved clearance of effusion at 1 month or | Nausea, vomiting, diarrhea (2% to 32% depending on |
less, 14.0% (95% CI [3.6%, 24.2%]); possible | dose and antibiotic); cutaneous reactions (<= 5%); | |
reduction in future infections | numerous rare organ system effects, including very | |
rare fatalities; cost; possible development of resistant | ||
strains of bacteria | ||
Antibiotics plus steroids | Possible improved clearance at 1 month, 25.1% | See antibiotics and steroids separately |
(95% CI [-1.3%, 49.9%])§; possible reduction | ||
in future infections. | ||
Steroids alone | Possible improved clearance at 1 month, 4.5% | Possible exacerbation of varicella; long-term |
(95% CI [-11.7%, 20.6%])§ | complications not established for low doses; cost | |
Antihistamine/decongestant | Same as base case | Drowsiness and/or excitability¶; cost |
Myringotomy with tubes | Immediate clearance of effusion in all children; | Invasive procedure; anesthesia risk; cost; |
improved hearing | tympanosclerosis; otorrhea; possible restrictions on | |
swimming | ||
Adenoidectomy | Benefits for young children have not been | Invasive procedure¶; anesthesia risk; cost |
established | ||
Tonsillectomy | Same as base case | Invasive procedure¶; anesthesia risk; cost |
* The target patient is an otherwise healthy child age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. ‡ Outcomes are reported as differences from observation, which is treated as the base case. When possible, meta-analysis was performed to provide a mean and associated confidence interval (CI). § Difference from base case not statistically significant. ¶ Risks were not examined in detail because no benefits were identified. |