Clinical Question: Are ventilation tubes effective in managing children who have otitis media with effusion?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Allocation: Concealed

Synopsis: This research team systematically reviewed several databases (including PubMed and Cochrane) for randomized controlled trials of ventilation tubes for children who have otitis media with effusion. Ultimately, seven studies (involving a total of 1,234 children) that were randomized to “a high standard” (i.e., concealed allocation) were included. The researchers contacted the authors of these studies to obtain individual patient data. After pooling all of these data, the researchers evaluated three outcomes: duration of the effusion, hearing, and language development. Because each of the studies had slightly different intermediate (six and nine months) and final (12 and 18 months) follow-up periods, the researchers aggregated them.

Children with tubes had a shorter duration of effusions (19.7 versus 37.0 weeks; P = .001) than the control patients. At six months of follow-up, the mean hearing level was 26.6 decibels in the children with tubes compared with 31.1 decibels in the control group (P = .001). However, by the time of the final follow-up 12 to 18 months later, there were no differences in hearing. Finally, the tubes had no effect on language development. The researchers suggest that children attending daycare and/or those with worse hearing loss at baseline may benefit more from tubes, but this conclusion requires further study.

Bottom Line: Compared with watchful waiting, inserting pressure-equalizing tubes improves hearing in children who have otitis media with effusion over the short term. Outcomes within 18 months, however, are the same. The tubes have no effect on language development. Watchful waiting is a reasonable option in most of these children. (Level of Evidence: 1b)