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Am Fam Physician. 2002;65(4):714

Otitis media with effusion is defined as an accumulation of fluid in the middle ear with no sign of acute inflammation. This is a common problem in children, with a prevalence of approximately 20 percent in two-year-olds. The effusion usually resolves over time, but it is the leading cause of acquired hearing loss. Hearing loss in this age group can have a negative impact on language development. Currently, there are multiple treatment regimens for otitis media with effusion, including the use of systemic or topical nasal steroids. In theory, steroids should improve the resolution time of the effusion, but few studies have supported this idea. Butler and van der Voort examined the published data to determine if there is a place for steroid treatment in otitis media with effusion.

The authors performed a literature review of the aspects of otitis media with effusion and steroid treatment. The analysis included 10 published studies with randomized controlled trials of oral or topical nasal steroids alone or in combination with other agents such as antibiotics. The authors looked for differences in hearing levels, degree of conductive hearing loss, presence or absence of fluid in the middle ear (short- and long-term), and possible adverse effects.

The results showed that short-term resolution of effusion in otitis media was better in the children treated with steroids, but there was no long-term improvement in effusion rates or hearing improvement. Most of these studies compared steroids plus antibiotics with antibiotics alone. The results did show that there were no serious or lasting adverse effects of steroid therapy.

The authors conclude that steroids should not be used in the treatment of otitis media with effusion. They note that the literature does support short-term gains with steroid treatment, but that there is no long-term benefit to this therapy.

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Copyright © 2002 by the American Academy of Family Physicians.

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