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Intervention Review

Autoinflation for hearing loss associated with otitis media with effusion

  1. Rafael Perera*,
  2. Jayne Haynes,
  3. Paul P Glasziou,
  4. Carl J Heneghan

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 17 AUG 2006

DOI: 10.1002/14651858.CD006285

How to Cite

Perera R, Haynes J, Glasziou PP, Heneghan CJ. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006285. DOI: 10.1002/14651858.CD006285.

Author Information

  1. University of Oxford, Department of Primary Health Care, Oxford, UK

*Rafael Perera, Department of Primary Health Care, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK. rafael.perera@dphpc.ox.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Otitis media with effusion (OME) or 'glue ear' is an accumulation of fluid in the middle ear, in the absence of acute inflammation or infection. It is the commonest cause of acquired hearing loss in childhood and the usual reason for insertion of 'grommets'. Potential treatments include decongestants, mucolytics, steroids, antihistamines and antibiotics. Autoinflation devices have been proposed as a simple mechanical means of improving 'glue ear'.

Objectives

To determine the effects of autoinflation in adults and children with otitis media with effusion.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, CENTRAL (The Cochrane Library Issue 1, 2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006) and twelve other databases, using the Cochrane Ear, Nose and Throat Disorders Group search strategy.

Selection criteria

We selected randomised controlled trials that compared any form of autoinflation to no autoinflation in individuals with 'glue ear'.

Data collection and analysis

Two review authors independently assessed studies for inclusion, assessed quality and extracted data from included studies.

Main results

Six studies met the inclusion criteria. Improvement occurred for the composite measure of tympanogram or audiometry at less than one month (Relative Risk of Improvement (RRI) 2.47, 95% confidence interval (CI) 0.93 to 6.58) and at more than one month (RRI 2.20, 95% CI 1.71 to 2.82). Subgroup analysis based on the type of intervention showed a significant effect using a Politzer device under one month (RRI 7.07, 95% CI 3.70 to 13.51) and over one month (RRI 2.25, 95% CI 1.67 to 3.04).

Pooled estimates showed non-significant change in tympanometry (type C2 and B) at less than one month (RRI 1.65, 95% CI 0.49 to 5.56) and non-significant improvement in tympanometry at greater than one month (RRI 1.89, 95% CI 0.77 to 4.67). Non-significant improvements occurred for discrete pure tone audiometry (RRI 0.80, 95% CI 0.22 to 2.88) and non-discrete audiometry (WMD 6.95 dB, 95% CI 21.03 to 7.13). None of the studies demonstrated a significant difference in the incidence of side effects between interventions.

Authors' conclusions

All of the studies were small, of limited treatment duration and short follow up. However, because of the low cost and absence of adverse effects it is reasonable to consider autoinflation whilst awaiting natural resolution of otitis media with effusion. Further research should consider the duration of treatment and the long-term impact of autoinflation on developmental outcomes in children.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Autoinflation for hearing loss associated with otitis media with effusion (glue ear)

Otitis media with effusion (OME) or 'glue ear' is very common in children and the hearing loss and discomfort, especially where the effusion is bilateral and long-lasting, may lead to problems with language, development and behaviour. There are a number of treatment options including steroids, antibiotics, decongestants, antihistamines and surgery (the insertion of grommets (ventilation tubes)). Grommet insertion is one of the commonest operations of childhood. The best treatment strategy remains controversial, however, as glue ear often resolves spontaneously within a few months.

Autoinflation is a technique whereby the Eustachian tube (the tube that connects the middle ear and the back of the nose) is reopened by raising pressure in the nose. This can be achieved by forced exhalation with closed mouth and nose, blowing up a balloon through each nostril or using an anaesthetic mask. The aim is to introduce air into the middle ear, via the Eustachian tube, equalising the pressures and allowing better drainage of the fluid.

This review included six randomised controlled trials of autoinflation for glue ear. All of the studies were small, of limited treatment duration and short follow up.

The review authors used a combined outcome measure which included any outcome signifying improvement (as defined in individual studies) and measured outcomes at the time points 'up to one month' and 'greater than one month'. Improvement was demonstrated in both the 'up to one month' and 'greater than one month' analyses. Subgroup analysis based on the type of intervention showed a significant effect using a Politzer device at both under one month and over one month. None of the studies demonstrated a significant difference in the incidence of side effects between interventions.

The authors conclude that evidence for the use of autoinflation in the short term is favourable. However, given the small number of studies and the lack of long-term follow up, the long-term effects associated with the use of these devices cannot be determined.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用自動充氣法來治療中耳積液造成的聽力喪失

中耳積液(OME)或“膠狀耳”‘glue ear’是指液體累積在中耳腔,但無合併急性發炎或感染,它是兒童最常見後天性聽力障礙及裝置中耳通氣管“grommets”的原因。其可能的治療包括去充血劑、化痰劑、類固醇、抗組織胺、及抗生素。自動充氣儀器已被推薦成一種簡單手工操作的工具來改善“膠狀耳”

目標

確認用自動充氣法在成人及兒童中耳積液的效果

搜尋策略

用Cochrane Ear, Nose and Throat Disorders Group 搜尋策略來搜尋the Cochrane Ear, Nose and Throat Disorders Group Trials Register, CENTRAL (The Cochrane Library Issue 1, 2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006)及其他12種資料庫

選擇標準

有“膠狀耳”的病患中,比較任何形式的自動充氣法與無自動充氣的隨機對照試驗

資料收集與分析

兩位評論者各自評估研究的收集標準及品質,並從所收集的研究中摘取資料

主要結論

6個研究符合收集標準。改善標準用兩種測量方式包括鼓室圖及聽力圖,一個月內改善之相對風險(RRI)是2.47(95% 信賴區間(CI) 0.93 – 6.58),超過一個月改善之相對風險是2.20(95% CI 1.71 – 2.82)。以處置的種類作次群分析顯示用Politzer儀器有明顯效果,在一個月內改善之相對風險是7.07(95% CI 3.70 – 13.51),超過一個月改善之相對風險是2.25(95% CI 1.67 – 3.04)。整體的評價顯示鼓室圖(type C2及B)在一個月內無明顯改變(RRI 1.65, 95% CI 0.49 – 5.56),超過一個月也無明顯改善(RRI 1.89, 95% CI 0.77 – 4.67)。在離散的純音聽力測量顯示無明顯進步(RRI 0.80, 95% CI 0.22 – 2.88),非離散的純音聽力測量也無明顯進步(WMD 6.95 dB, 95% CI 21.03 – 7.13)。這些研究報告關於不同處置間的副作用機率並無明顯不同

作者結論

所有研究都屬小型、短時間的治療及追蹤期。但由於便宜且無不良作用,在等待中耳積液自然消退的時間中考慮用自動充氣法是合理的。將來的研究需考慮治療的時間,及自動充氣法對兒童發育長期之影響

翻譯人

本摘要由國泰綜合醫院方德詠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

用自動充氣法來治療中耳積液造成的聽力喪失(膠狀耳):中耳積液(OME)或“膠狀耳”在兒童中非常常見,且其不舒服症狀及聽力喪失會造成語言、發展、及行為問題,尤其在雙側中耳積液且持續長時間的兒童。目前有一些治療的選擇,包括類固醇、抗生素、去充血劑、抗組織胺、和手術(置入grommet(中耳通氣管))。置入grommet是兒童最常見的手術之ㄧ。由於膠狀耳在幾個月後常自動消退,所以最佳治療策略仍有爭議性。自動充氣法是藉由升高鼻腔壓力來使歐氏管(連接中耳腔及鼻腔後部的管子)再打開的技巧,這可經由關閉口部及鼻部後強迫吐氣、經單個鼻孔吹脹氣球、或利用麻醉面罩來達成,目的在讓空氣經歐氏管進入中耳腔、平衡壓力、並讓液體有較佳的引流。這篇回顧包括6個關於自動充氣法用在膠狀耳的隨機對照試驗,所有研究都屬小型、短時間的治療及追蹤期。這篇作者合併所有研究的結果評量方式,包括任何可代表進步的結果(依個別研究中的定義),且在“一個月內”及“一個月後”進行評量。分析“一個月內”及“一個月後”的結果來表示改善程度。以處置的種類作次群分析顯示用Politzer儀器,不論在一個月內或一個月後都有明顯效果。這些研究報告關於不同處置間的副作用機率並無明顯不同。作者總結這些證據顯示自動充氣法在短期內的效果是好的,但由於小型研究及缺少長期追蹤,用這些儀器的長期效果無法確認