|
SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
9/14/06
Corticosteroid therapy in otitis media with effusion
Summary
Background – Otitis media with effusion (OME) continues to be a very common problem in childhood with the potential for adverse effects on hearing and subsequent speech development in a developing child. Allergic rhinitis (AR) and OME are frequently considered as co-morbidities. Is corticosteroid (CS) therapy (often effective in AR) beneficial in OME?
Findings – This subject was discussed by Dhooge et al of Ghent Univ Hospital in Belgium. They pointed out that the pathogenesis of OME involves: 1) inflammatory reactions directly involving the middle ear; 2) impairment of eustachian tube (ET) function. Allergic reactions in the nasal mucosa can cause ET dysfunction predisposing to OME development. Different studies have found varying degrees of association between AR and OME. Only some children with AR, even when severe, will manifest recurrent OME However, it does appear that the inflammatory profile in the middle ear fluid is different when the OME is accompanied by allergic respiratory conditions.
No efficacy of antihistamine (AH) treatment on the course of OME has been found even when nasal symptoms are reduced. Because systemic and intranasal corticosteroid (CS) therapy is frequently very beneficial in AR, it has been considered that such CS therapy would reduce the duration and/or severity of OME episodes. However, studies of CS effects are few, methodologically weak and inconclusive with no really impressive improvement noted.
Reference
Current Allergy and Asthma Reports 2006;6:327-33
Editor's Comments
My feeling, after reviewing this report, is one of continued puzzlement about the best way to approach OME, which typically starts asymptomatically and not linked to an acute otitis media episode. A set of guidelines by experienced clinicians does not recommend screening all children for OME though periodic hearing tests are usually done (see Otolaryngol Head, Neck Surg 2004;130:S95-S118). Evaluation of all children with OME for respiratory allergies is not usually cost-effective
unless there are nasal symptoms of AR. A recent meta-analysis concluded that oral, and possibly intra-nasal CS therapy significantly reduced the duration of OME episodes but had no significant longer term beneficial effects (Cochrane Database Sys Rev 2006;3:CD001935). One should see more definitive evidence of the efficacy of CS therapy in OME before employing this approach routinely.
|