Identification (through screening) of children in the first four years of life for early treatment for otitis media with effusion (OME)

Otitis media with effusion (OME - also known as 'glue ear') is a common condition in children, where sticky fluid accumulates in the middle ear. Although the fluid usually resolves without treatment, it may remain and cause long periods of hearing loss. This may lead to problems with language development and behaviour. Children with OME may show no other symptoms so some have suggested that all children should be checked (screened) for this condition. However, the review of trials in the developed world found that checking children for, and early treatment of, OME before they are four does not result in improved outcomes.

Authors' conclusions: 

The identified randomised trials do not show an important benefit on language development and behaviour from screening of the general population of asymptomatic children in the first four years of life for OME. However, these trials were all conducted in developed countries. Evidence generated in the developed world, where children may enjoy better nutrition, better living conditions and less severe and different infections, may not be applicable to children in developing countries. The screening aspect of some of these studies was aimed primarily at identifying suitable children in whom to evaluate the effects of treatment, rather than to evaluate the effects of screening programmes. Younger children and children with milder disease may have been included in these treatment trials compared to children who are offered treatment in pragmatic settings.

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Background: 

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2003 and previously updated in 2006.

Otitis media with effusion (OME) is the most common cause of acquired hearing loss in childhood and has been associated with delayed language development and behavioural problems. Some have argued that children should be screened and treated early if found to have clinically important OME, however there is a high rate of spontaneous resolution and in some children effusions may not reduce hearing significantly or impact negatively on language development or behaviour.

Objectives: 

The aim of this review was to assess evidence from randomised controlled trials about the effect, on language and behavioural outcomes, of screening and treating children with clinically important OME in the first four years of their life.

Search strategy: 

Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and additional sources for published and unpublished trials. The date of the most recent search was 30 June 2009, following previous update searches in January 2006 and original searches in February 2002.

Selection criteria: 

1. Randomised controlled trials evaluating interventions for OME among children with OME identified through screening.
2. Comparison of outcomes for children randomised to be screened for OME and outcomes for children who were not randomised to be screened for OME.

Data collection and analysis: 

Four authors independently extracted data and assessed trial quality; two in the original review and two for the updates.

Main results: 

We identified no trials comparing outcomes for children randomised to be screened for OME with outcomes for children who were not randomised to be screened for OME. We identified three trials (668 participants) evaluating interventions for OME among children with OME identified through screening, one of which generated five published studies. These were trials of treatment in children identified through screening rather than trials of treatment programmes. From these trials, we found no evidence of a clinically important benefit in language development from screening and treating children with clinically important OME.

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