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Autoinflation for hearing loss associated with otitis media with effusion

  • Review
  • Intervention

Authors


Abstract

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

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.

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