Outcomes of Treating Otitis Media With Effusion *
|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|
|Adenoidectomy||Benefits for young children have not been||Invasive procedure¶; anesthesia risk; cost|
|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.