Grommets (ventilation tubes) for recurrent acute otitis media in children
Abstract
Background
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2008.
Acute suppurative otitis media is one of the most common infectious diseases in childhood. Recurrent acute otitis media is defined for the purposes of this review as either three or more acute infections of the middle ear cleft in a six‐month period, or at least four episodes in a year. Strategies for managing the condition include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of ventilation tubes (grommets).
Objectives
To establish whether grommet insertion reduces the frequency of episodes of recurrent acute otitis media and the proportion of children with symptoms of ear disease.
Search methods
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 11 January 2011.
Selection criteria
Randomised controlled trials comparing grommet insertion versus control (antibiotics/other treatments/no treatment) for recurrent acute otitis media in children aged from 0 to 16 years.
Data collection and analysis
Two authors independently selected studies; three authors independently assessed study quality and extracted data. We synthesised data descriptively.
Main results
Two studies involving 148 children were included in the review. One of these studies, involving 95 children, showed that grommet insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. This study also showed a significant increase in the proportion of children with no episodes of acute otitis media (P < 0.001) in the grommet group. The other included study also found a higher proportion of patients in the grommet group had no episodes of acute otitis media in the six months after intervention, but the difference did not reach statistical significance (P = 0.16).
Authors' conclusions
Grommets have a significant role in maintaining a 'disease‐free' state in the first six months after insertion. Further research is required to investigate the effect beyond six months. Clinicians should consider the possible adverse effects of grommet insertion before surgery is undertaken.
PICOs
Plain language summary
Grommets (ventilation tubes) for recurrent acute otitis media in children
Acute otitis media is a common disease of childhood, involving inflammation of the space behind the eardrum (the middle ear cleft). Episodes typically involve a fever and a build up of pus that stretches the eardrum causing severe pain. The drum may then rupture, relieving the pain, and a discharge of pus enters the ear canal. A small proportion of children suffer with recurrent acute otitis media, which is defined as either three or more acute infections of the middle ear cleft in a six‐month period, or at least four episodes in a year.
One of the strategies used to treat this condition is the insertion of a miniature plastic ventilation tube (or grommet) into the eardrum, which prevents the painful accumulation of pus in the middle ear. This review aims to assess the evidence for the effectiveness of this treatment in reducing recurrent acute otitis media.
We searched for scientific studies which compared treating children with recurrent acute otitis media with either grommets or a non‐surgical treatment such as antibiotics (or no treatment). In these studies, children with grommets in place were considered to have suffered an episode of acute otitis media if they had a discharge of pus from the ear.
Two suitable studies were found to be suitable for further analysis. The combined results from these two studies suggested that more children treated with grommets are rendered symptom‐free in the six months following surgery compared to those who receive other treatments or no treatment. One of the two included studies, involving 95 children, showed that grommets reduce the number of episodes of acute otitis media in the first six months after surgery, by an average of 1.5 episodes per child.
When considering the size of this effect, it is important to bear in mind that the studies were not perfect in their design and execution. To be confident in these findings further high‐quality research is required.
