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Reference - CMAJ 2015 Sep 22;187(13):961 (level 2 [mid-level] evidence)
Otitis media with effusion is a common cause of hearing impairment in children. Each year, 2.2 million new cases are diagnosed in the United States alone (Infect Drug Resist 2014 Jan 10;7:15). No medications have been found to successfully treat symptoms or improve outcomes and the American Academy of Pediatrics/American Academy of Family Physicians/American Academy of Otolaryngology-Head and Neck Surgery (AAP/AAFP/AAO) specifically recommend against using antihistamines, decongestants, antimicrobials, or corticosteroids (Pediatrics 2004 May;113(5):1412). Watchful waiting is recommended for most children, but surgery may be indicated in children with persistent symptoms, hearing loss, or structural damage. Autoinflation with a nasal balloon has been suggested as a possible therapy for otitis media with effusion, but previous data has been limited by small trial size, short treatment duration, and limited follow-up (Cochrane Database Syst Rev 2013 May 31;(5):CD006285). A recent randomized trial compared autoinflation 3 times daily for 1-3 months plus usual care vs. usual care alone in 320 children aged 4-11 years (mean age 5 years) with a history of hearing loss or other ear symptoms in the previous 3 months.
Fifty-seven percent of children had otitis media with effusion in 1 ear and 42% had it in both ears. The 1-month analysis included 82.2% of children randomized and the 3-month analysis included 76.6%. Tympanometric resolution of otitis media with effusion at 1 month occurred in 47.3% of children with autoinflation vs. 35.6% of children with usual care alone (not significant). By 3 months, autoinflation resulted in tympanometric resolution in 49.6% of children vs. 38.3% with usual care alone (p < 0.05, NNT 9). Analysis by individual ears yielded similar results. Autoinflation was also associated with increased improvements in ear-related quality of life and fewer symptomatic days at the 3-month analysis. The rate of nose-bleeds was similar between groups, but a greater number of respiratory infections were reported in children with autoinflation (not significant).
The results of this trial suggest that the simple, at home technique of nasal balloon autoinflation may help reduce symptoms and increase tympanometric resolution of otitis media with effusion in symptomatic children. This non-surgical treatment option has efficacy, however the overall effectiveness was modest, as only about 50% of children had tympanometric resolution with autoinflation. Furthermore, it is unknown if this technique reduced recurrence or the need for surgical intervention after 3 months.
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Errata: We have made a minor modification the text of last week’s EBM Focus to improve clarity. Please see the Archives for the corrected version.