SEARCH

SEARCH BY CITATION

Keywords:

  • evidence-based medicine;
  • health policy;
  • otitis media;
  • paediatrics

Abstract

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES

Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.

Excerpts from: Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD003423. DOI: 10.1002/14651858.CD003423.pub3

Otitis media with effusion

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES

Otitis media with effusion (OME), or ‘glue ear’, is characterized by an accumulation of fluid in the middle ear, in the absence of acute inflammation. It is very common in children, especially between the ages of 1 and 3 years and in seasons where the prevalence of upper respiratory tract infections (‘colds’) is high, with an incidence of 10% to 30%. It occurs frequently even up to the age of 7, with a prevalence of 3% to 8% 1–4. The OME is the commonest cause of acquired hearing loss in childhood. The OME usually resolves spontaneously within few months 5, 6.

Why use antihistamines and decongestants?

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES

Theoretically, antihistamines may reduce the congestion of mucous membranes and decrease obstruction of tubes lined by mucous membrane, such as the Eustachian tube. An open Eustachian tube would allow the middle ear pressure to equalize to ambient air pressure. It may also allow drainage of fluid from the middle ear. Decongestants are vasoconstrictors and should reduce mucous membrane swelling and enhance Eustachian tube function.

What should we do in practice?

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES

We found no benefit from any of the studied interventions for any of the outcomes measured and also found harm from the side effects of the interventions; therefore, we recommend practitioners not to use antihistamines, decongestants or antihistamine and decongestant combinations to treat OME in children.

What do the guidelines suggest?

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES
American Academy of Pediatrics 7The prior OME guideline (published in 1994) found no data supporting antihistamine–decongestant combinations in treating OME
Canadian Pediatric Society 8No mention of antihistamines or decongestants; only antimicrobial treatment was discussed
NICE 9Antihistamines and decongestants are included in the list headed ‘The following treatments are not recommended for the management of OME’
Dutch College of General Practitioners 10Antihistaminica en intranasale decongestiva zijn niet effectief bij otitis media met effusie. (Antihistamines and intranasal decongestants are not effective in otitis media with effusion)

Evidence-Based Child Health, Editorial Office

Evidence-Based Child Health Canadian editorial office. E-mail: child@ualberta.ca

Commentary by E. Cohen

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES

Primum non nocere (first, do no harm) holds true here. In 2008, the Food and Drug Administration warned of potential harms from cough and cold products containing antihistamines and decongestants in children younger than 2 years, and provided caution for their use in children aged 2–11 years pending a detailed review 11. The potential risks included a wide variety of rare but serious adverse events, including death from accidental ingestion, unintentional overdose or dosing error. Combining these potential harms with the knowledge of the usually self-limited course of OME leads to a simple conclusion. Antihistamines and decongestants should disappear from clinical practice when treating OME in young children.

REFERENCES

  1. Top of page
  2. Abstract
  3. Otitis media with effusion
  4. Why use antihistamines and decongestants?
  5. What should we do in practice?
  6. What do the guidelines suggest?
  7. Commentary by E. Cohen
  8. Declaration of interest
  9. REFERENCES
  • 1
    Fiellau-Nikolajsen M. Tympanometry and secretory otitis media. Observations on diagnosis, epidemiology, treatment, and prevention in prospective cohort studies of three-year-old children. Acta Otolaryngol Stockholm Suppl 1983; 394: 173. Epub January 1983.
  • 2
    Fiellau-Nikolajsen M, Lous J, Vang Pedersen S, Schousboe HH. Tympanometry in three-year-old children. I. A regional prevalence study on the distribution of tympanometric results in a non-selected population of 3-year-old children. Scand Audiol 1977; 6: 199204. Epub January 1977.
  • 3
    Lous J, Fiellau-Nikolajsen M. Epidemiology and middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387 non-selected 7-year-old children. Int J Pediatr Otorhinolaryngol 1981; 3: 303317. Epub December 1981.
  • 4
    Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989; 160: 8394. Epub July 1989.
  • 5
    Fiellau-Nikolajsen M, Lous J. Prospective tympanometry in 3-year-old children. A study of the spontaneous course of tympanometry types in a nonselected population. Arch Otolaryngol 1979; 105: 461466. Epub August 1979.
  • 6
    Rosenfeld RM, Bluestone CD. Evidence-Based Otitis Media. Hamilton, Ontario: Decker; 1999.
  • 7
    American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis Media With Effusion. Pediatrics 2004; 113: 14121429.
  • 8
    Forgie SZG, Robinson J, Canadian Paediatric Society. Position Statement: Management of acute otitis media. Paediatr Child Health 2009; 14: 457460. Epub September 2009.
  • 9
    National Institute for Health and Clinical Excellence (2013). Surgical Management of OME. NICE Clinical Guideline 60 [Internet], [8 p.]. Available at: http://www.nice.org.uk/usingguidance/donotdorecommendations/detail.jsp?action=details&dndid=183 [accessed on 8 January 2013].
  • 10
    Van Balen FAM RM, Eekhof JAH, Van Weert HCPM, Eizenga WH, Boomsma LJ (2013). NHG-Standard Otitis Media Met Effusie (Tweede Herziening). NHG-Standaarden M18 [Internet]. Available at: http://nhg.artsennet.nl/kenniscentrum/k_richtlijnen/k_nhgstandaarden/NHGStandaard/M18_std.htm#Richtlijnenbeleid [accessed on 15 January 2013].
  • 11
    US Food and Drug Administration. Public Health Advisory: Nonprescription Cough and Cold Medication Use in Children. 2008. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116839.htm (Accessed 6 February 2013).