Are nasal steroid sprays effective for otitis media with effusion?
Recommendations from others
The Canadian Task Force on Preventative Health Care found insufficient evidence to recommend screening for OME to prevent delayed language development.5
The Cochrane Ear, Nose and Throat Disorders Group concludes that both oral and topical intranasal steroids alone or in combination with an antibiotic lead to a quicker resolution of OME in the short term, but no long-term benefit is seen from treating OME effusions or associated hearing loss with topical intranasal steroids.6 They separately reviewed antibiotic treatment for OME, noting the short-term benefit above, but cited several drawbacks including cost and increased antibacterial resistance.7
The American Academy of Family Physicians Clinical Recommendation on Otitis Media with Effusion in Young Children does not recommend steroid medications for treatment of OME in a child of any age.8
Fred Grover, Jr, MD
Department of Family Medicine, University of Colorado, Denver
Management of OME can be challenging and expensive—annual costs are estimated at $5 billion. Antibiotics are often inappropriately prescribed for OME, which may promote bacterial resistance. Commonly, clinicians augment OME treatment with antihistamines, decongestants, and steroids. Yet studies such as those cited above confirm that these treatments offer limited or no benefit. We must avoid the kitchen-sink treatment of OME. Furthermore, randomized controlled trials have shown that 80% to 90% of cases of acute otitis media and OME resolve without any therapy.
However, children with chronic OME, especially those with bilateral disease or possible hearing loss, may benefit from tympanostomy tube placement and adenoidectomy. If the OME doesn’t clear within 3 months, refer to an ear, nose, and throat specialist.
Prevention efforts are valuable. Immunization of infants with pneumococcal conjugate vaccine reduced tympanostomy tube placement by 20% to 39%.9,10 Since increased incidence of OME and recurrent acute otitis media are associated with secondhand smoke exposure, motivating parents to quit smoking may further reduce chronic OME.
ACKNOWLEDGMENTS
Thanks to Marianne Broers, MD for her translation of reference 1 from Dutch.
