Autoinflation for hearing loss associated with otitis media with effusion

Rafael Perera; Jayne Haynes; Paul P Glasziou; Carl J Heneghan

doi:10.1002/14651858.CD006285

Autoinsuflación para la hipoacusia asociada a la otitis media con derrame

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Referencias

Referencias de los estudios incluidos en esta revisión

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Arick D, Silman S. Nonsurgical home treatment of middle ear effusion and associated hearing loss in children Part I: Clinical trial. Ear, Nose and Throat Journal 2005;84(9):567‐78.

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Lesinskas E. Factors affecting the results of nonsurgical treatment of secretory otitis media in adults. Auris, Nasus, Larynx 2003;30:7‐14.

Stangerup S, Sederberg‐Olsen J, Balle V. Autoinflation as a treatment of secretory otitis media: a randomized controlled study. Archives of Otolaryngology ‐ Head and Neck Surgery 1992;118:149‐52.

Stangerup S, Tos M. Autoinflation in the treatment of Eustachian tube dysfunction, secretory otitis media and its sequelae. Recent advances in otitis media. Amsterdam/New York: Kugler Publications, 1994:759‐63.

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Referencias de los estudios excluidos de esta revisión

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estudios a la espera de valoración
otras referencias

Alper CM, Swarts JD, Doyle W. Middle ear inflation for diagnosis and treatment of otitis media with effusion. Auris Nasus Larynx 1999;26:479‐86.

Arick D, Silmasn S. Treatment of otitis media with effusion based on polizterization with an automated device. Ear, Nose and Throat Journal 2000;79(4):290‐8.

Blanshard J. Autoinflation for otitis media with effusion. Maternal and Child Health 1995;September 1995:304‐7.

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Chan K, Bluestone CD. Lack of efficacy of middle‐ear inflation: treatment of otitis media with effusion in children. Otolaryngology ‐ Head and Neck Surgery 1989;100(4):317‐23.

Gottschalk GH. Further experience with controlled middle ear inflation in the treatment of serous otitis. The eye, ear, nose and throat monthly 1966;45:49‐51.

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Gottschalk GH. Middle ear inflation: its place in the treatment of otitis media with effusion. The Eustachian Tube, clinical aspects. 1991:293‐5.

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Hanner P. Non surgical treatment of otitis media with effusion. Indian Journal of Otology 1997;3(3):101‐7.

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Havas T, Koutsis A, Jacobson I. Nasal ballon auto‐inflation (Otovent) as a treatment of otitis media with effusion in children. Journal of the Oto‐laryngological Society of Australia 1995;2(1):37‐41.

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Kaneko Y, Takasaka T, Sakuma M, Kambayashi J, Okitsu T. Middle ear inflation as a treatment for secretory otitis media in children. Acta Otolaryngologica (Stockholm) 1997;117:564‐8.

Kouwen H, van Balen FAM, Dejonckere PH. Functional tubal therapy for persistent otitis media with effusion in children: Myth or evidence?. International Journal of Pediatric Otorhinolaryngology 2005;69:943‐51.

Kutácová, S, Komínek, P, Horník. P. S. Autoinflation in curing up the middle ear inflammation.. Otorinolaryngologie a Foniatrie {Otorinolaryngol‐Foniatr} 2005;54(1):52‐55.

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Leunig A. Middle ear aeration with the Otovent‐latex membrane system. Laryno‐Rhino‐Otologie 1995;74(b):352‐4.

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Luntz M, Sadé J. The diagnostic and therapeutic value of middle ear inflation. The Eustachian tube, basic aspects. 1991:183‐5.

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Ogawa I. Otitis media with effusion: treatment by autoinflation using a balloon. J Otolaryngol Jpn 2003;106:685‐91.

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Yu L, Ma X. Trans‐external ear canal blow oxygen method. Lin Chuang Er Bi Yan Hou Ke Zsa Zhi [Journal of Clinical Otorhinolaryngology] 2003;17(1):35‐6.

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Referencias de los estudios en espera de evaluación

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estudios excluidos
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Referencias adicionales

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estudios incluidos
estudios excluidos
estudios a la espera de valoración

Bluestone CD, Klein JO. Otitis Media in Infants and Children. Philadelphia: WB Saunders Company, 1988.

Deeks JJ, Higgins, JPT, Altman DG. Section 8.11.2.2 Approximate analyses of cluster‐randomized trials for a meta‐analysis: Effective sample sizes. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. Cochrane Collaboration, May 2005. [http://www.cochrane.org/resources/handbook/hbook.htm]

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Fiellau‐Nikolajsen M. Tympanometry and secretory otitis media. Observations on diagnosis, epidemiology, treatment, and prevention in prospective cohort studies of three‐year‐old children [thesis]. Acta Oto‐Laryngologica Supplementum 1983;394:1‐73.

Golz A, Netzer A, Angel‐Yeger B, Westerman ST, Gilbert LM, Joachims HZ. Effects of middle ear effusions on the vestibular system in children. Otolaryngology ‐ Head and Neck Surgery 1998;119(6):695‐9.

Grace AR, Pfleiderer AG. Dysequilibrium and otitis media with effusion: what is the association?. Journal of Laryngology and Otology 1990;104(9):682‐4.

Hunt‐Williams R. A method of maintaining middle ear ventilation in children. Journal of Laryngology and Otology 1968;82:921.

Jerger J. Clinical experience with impedance audiometry. Archives of Otolaryngology 1970;92(4):311‐24.

Lous J, Fiellau‐Nikolajsen M. Epidemiology of middle ear effusion and tubal dysfunction: a one‐year prospective study comprising monthly tympanometry in 387 non‐selected 7‐year‐old children. International Journal of Pediatric Otorhinolaryngology 1981;3(4):303‐17.

Lous J. Secretory otitis media in schoolchildren. Is screening for secretory otitis media advisable?. Danish Medical Bulletin 1995;42(1):71‐99.

Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database of Systematic Reviews 2005, Issue 1. [Art. No.: CD001801. DOI: 10.1002/14651858.CD001801.pub2]

Reidpath DD, Glasziou PP, Del Mar CD. Systemic review of autoinflation for treatment of glue ear. British Medical Journal 1999;318:1177‐8.

Rovers MM, Zielhuis GA, Straatman H, Ingels K, van der Wilt GJ, Kauffman‐de Boer M. Comparison of the CAPAS and Ewing tests for screening of hearing in infants. Journal of Medical Screening 1999;6(4):188‐92.

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. Journal of Infectious Diseases 1989;160(1):83‐94.

Thomas CL, Simpson S, Butler CC, van der Voort JH. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database of Systematic Reviews 2006, Issue 3. [Art. No.: CD001935. DOI: 10.1002/14651858.CD001935.pub2]

Zielhuis GA, Rach GH, van den Broek P. Screening for otitis media with effusion in preschool children. The Lancet 1989;1(8633):311‐4.

Zielhuis GA, Rach GH, van‐den‐Broek P. The occurrence of otitis media with effusion in Dutch pre‐school children. Clinical Otolaryngology and Allied Sciences 1990;15(2):147‐53.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Arick 2005

Methods	Randomised controlled trial
Participants	Bilateral or unilateral OME on audiometry and otoscopy. 94 Children. Inclusion: 1) aged 4 to 11 years 2) at least 2 month history of MEE and associated hearing loss documented by physician 3) pure tone conduction thresholds of 20 dB HL or more (500 Hz to 4000 Hz) 4) a tympanometric peak pressure (TPP) of ‐100 daPa or less 5) otologic diagnosis of MEE at pretest 6) absence of enlarged adenoids, acute otitis media or other ear abnormalities at pretest.
Interventions	Modified Politzer device for 7 weeks. Parent administered twice daily alternating nostrils. Control group received equal care except for the intervention.
Outcomes	Air conduction thresholds for each ear (500 Hz to 4000 Hz), TPP, hearing recovery (by patients and by ears). Data on outcome was obtained for all individuals. Adherence was reported in 97.9% in the intervention group.
Notes	Results reported as continuous for all outcomes except hearing recovery. Randomisation not described in paper (e‐mail from author described randomisation as 4 pieces of paper (2 Exp, 2 contr) in a paper bag chosen by parent. Groups were comparable at outset.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Blanshard 1993

Methods	Randomised controlled trial
Participants	Bilateral OME on tympanometry. 85 children. 3 to 10 years on waiting list for ventilation tubes
Interventions	TDS Otovent 3 times a day or no treatment for 3 months. Control group received equal care except for the intervention.
Outcomes	Tympanometry (1, 2 and 3 months). Pure tone audiometry (3 months). Clearance of fluid on otoscopy (1, 2 and 3 months). Adverse effects (3 months). Between 93.4 and 95.8% follow up. 45% had high compliance, 43% low and 12% were unable to use device.
Notes	Results reported as ears. Intervention group subdivided into low compliance and high compliance. Original data obtained by JH and RP. Randomisation done by computer generated random numbers. Groups were comparable at outset, except for smoke exposure.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Brooker 1992

Methods	Randomised controlled trial (ears). Allocation was made "at random", there were no comparisons of the groups at baseline, and no statement about blinding.
Participants	Unilateral or bilateral OME diagnosed by otoscopy, audiometry and tympanometry. 40 children. Aged 3 to 10 referred to ENT.
Interventions	TDS carnival balloon 3 times a day or no treatment for 3 weeks. Both groups had equal care exept for the intervention.
Outcomes	Pure tone audiometry. Tympanometry (Both at 3 weeks). 100% follow up in both groups. Parents reported "good compliance".
Notes	Ears. Children unable to use the carnival blower excluded prior to randomisation. Randomisation procedure not described. Comparability of groups not stated.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Fraser 1977

Methods	Three factorial randomised controlled
Participants	Bilateral OME on tympanometry. 85 children. Aged 3 to 12.
Interventions	BD carnival blower or no treatment for six weeks. Other arms (factorial design) received equal care except for the intervention.
Outcomes	Pure tone audiometry. Tympanometry. (Both at 6 weeks). 97% follow up overall. Adherence not reported.
Notes	Children. Also randomised to one, both or neither of Dimotapp elixir or 0.5% ephedrine nosedrops. Randomisation not described. Groups were comparable at outset.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Lesinskas 2003

Methods	Randomised controlled trial
Participants	Unilateral or bilateral OME diagnosed by tympanometry and PTA. 198 adults aged 16 to 75.
Interventions	BD Politzer inflation 2 times a day for 10 days, with or without oral antibiotics, or no treatment. Control group received equal care except for the intervention.
Outcomes	Pooled score combining pneumo‐otoscopic appearance, tympanometry, patient complaint and audiometry (days 3 to 5, 10 and 60). 100% follow up and adherence (done by ENT doctor).
Notes	Results reported by ears. Randomisation of individuals done by independent person using envelopes. No data on group comparability at outset. Outcomes only presented as pooled data
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Stangerup 1992

Methods	Randomised controlled trial
Participants	Unilateral or bilateral OME for at least 3/12 diagnosed by tympanometry. 100 children. Aged 3 to 10.
Interventions	TDS Otovent 3 times a day for 2 weeks, extended to 4 weeks in those with persistent OME, or no treatment. Control group received equal care except for the intervention.
Outcomes	Tympanometry Otits media (days 14, 30, 60 and 90). Follow up of 82.4% in the intervention arm and 67.% in the control. At 2 weeks the adherence was 71.7% in the intervention group.
Notes	Results reported as ears. Randomisation done by individual, but not stated how. Groups were comparable at outset.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Characteristics of excluded studies [ordered by study ID]

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estudios incluidos

Study	Reason for exclusion
Alper 1999	ALLOCATION: Case report only.
Arick 2000	ALLOCATION: Not a randomised controlled trial.
Blanshard 1995	ALLOCATION: Comment ‐ not a randomised controlled trial.
Chan 1989	ALLOCATION: Participants were stratified according to their ability of tubal opening during autoinflation. Within each strata children were randomised to autoinflation or control using a set of random numbers. PARTICIPANTS: Criteria for diagnosing OME was otoscopy alone. No tympanometry or audiometry.
Gottschalk 1966	ALLOCATION: Comment ‐ not a randomised controlled trial.
Gottschalk 1991	ALLOCATION: Not a randomised controlled trial.
Hanner 1997	ALLOCATION: Randomised controlled trial. No details given on randomisation. PARTICIPANTS: 76 children with unilateral or bilateral negative middle ear pressure lower than ‐200 mm water (type C2 or B tympanometry) for at least three months verified by tympanometry and older than three years. INTERVENTION: Both intervention groups (children) received an "Autoinflation" treatment. Otovent (28) versus Valsalva manoeuvre (27).
Havas 1995	ALLOCATION: Not a randomised controlled trial.
Kaneko 1997	ALLOCATION: Not a randomised controlled trial.
Kouwen 2005	ALLOCATION: Randomised controlled trial. No information given on randomisation. PARTICIPANTS: 32 children aged two to five years with bilateral OME diagnosed by combined and repeated tympanometry and otoscopy. INTERVENTION: Comparison is functional therapy (15) versus watchful waiting (17), no autoinflation intervention. Functional therapy consisted in therapy by a speech pathologist, combining hygiene and behavioural changes with specific motoric exercises once a week for a period of three months.
Kutácová 2005	ALLOCATION: Comment ‐ not a randomised controlled trial.
Leunig 1995	ALLOCATION: Unable to determine if this was a randomised controlled trial. PARTICIPANTS: 146 children above four years with unilateral or bilateral OME ascertained by audiometry and tympanometry. INTERVENTION: Comparison is autoinflation versus paracentesis, not autoinflation versus control.
Luntz 1991	ALLOCATION: Not a randomised controlled trial.
Ogawa 2003	ALLOCATION: Not a randomised controlled trial.
Yu 2003	ALLOCATION: Not a randomised controlled trial.

Data and analyses

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Comparison 1. Tympanometry Improvement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Tympanogram improvement: 1 month or less Show forest plot	3		Relative risk (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.1 Comparison 1 Tympanometry Improvement, Outcome 1 Tympanogram improvement: 1 month or less.
1.1 B or C2 to C1 or A	3		Relative risk (Random, 95% CI)	1.65 [0.49, 5.56]
1.2 B to C1 or A	2		Relative risk (Random, 95% CI)	2.71 [1.43, 5.12]
1.3 C2 to C1 or A	2		Relative risk (Random, 95% CI)	3.84 [1.94, 7.59]
2 Tympanogram improvement: > 1 month Show forest plot	2		Relative Risk (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.2 Comparison 1 Tympanometry Improvement, Outcome 2 Tympanogram improvement: > 1 month.
2.1 B or C2 to C1 or A	2		Relative Risk (Random, 95% CI)	1.89 [0.77, 4.67]

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Comparison 2. Improvement (tympanogram or composite)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement composite: 1 month or less Show forest plot	4		Relative Risk (Random, 95% CI)	2.47 [0.93, 6.58]
Open in figure viewer Analysis 2.1 Comparison 2 Improvement (tympanogram or composite), Outcome 1 Improvement composite: 1 month or less.
2 Improvement composite: > 1 month Show forest plot	4		Relative Risk (Random, 95% CI)	2.20 [1.71, 2.82]
Open in figure viewer Analysis 2.2 Comparison 2 Improvement (tympanogram or composite), Outcome 2 Improvement composite: > 1 month.
3 Improvement composite by intervention: 1 month or less Show forest plot	4		Risk Ratio (Random, 95% CI)	2.47 [0.93, 6.58]
Open in figure viewer Analysis 2.3 Comparison 2 Improvement (tympanogram or composite), Outcome 3 Improvement composite by intervention: 1 month or less.
3.1 Intervention A ‐Classic Otovent or Carnival blower+balloon	3		Risk Ratio (Random, 95% CI)	1.65 [0.49, 5.55]
3.2 Intervention C ‐ Politzer	1		Risk Ratio (Random, 95% CI)	7.07 [3.70, 13.51]
4 Improvement composite by intervention: > 1 month Show forest plot	4		Risk Ratio (Random, 95% CI)	2.20 [1.71, 2.82]
Open in figure viewer Analysis 2.4 Comparison 2 Improvement (tympanogram or composite), Outcome 4 Improvement composite by intervention: > 1 month.
4.1 Intervention A ‐Classic Otovent or Carnival blower+balloon	2		Risk Ratio (Random, 95% CI)	1.89 [0.77, 4.67]
4.2 Intervention C ‐ Politzer	2		Risk Ratio (Random, 95% CI)	2.25 [1.67, 3.04]

Open in table viewer

Comparison 3. Audiometry Improvement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Average improvement >= 10 dB in pure tone audiogram (freq. 250 Hz to 2000 Hz) Show forest plot	2		Relative Risk (Random, 95% CI)	0.80 [0.22, 2.88]
Open in figure viewer Analysis 3.1 Comparison 3 Audiometry Improvement, Outcome 1 Average improvement >= 10 dB in pure tone audiogram (freq. 250 Hz to 2000 Hz).
2 Pure tone threshold Show forest plot	2		Mean difference (Random, 95% CI)	7.02 [‐6.92, 20.96]
Open in figure viewer Analysis 3.2 Comparison 3 Audiometry Improvement, Outcome 2 Pure tone threshold.

Figure 1

Otovent package.

Otovent® package containing balloons with device and instructions.

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Figure 2

Child using Otovent.

Child demonstrating the use of Otovent® device

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Figure 3

Politzer ‐ EarPopper.

Young woman demonstrating use of modified Politzer device (EarPopper™)

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Analysis 1.1

Comparison 1 Tympanometry Improvement, Outcome 1 Tympanogram improvement: 1 month or less.

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Analysis 1.2

Comparison 1 Tympanometry Improvement, Outcome 2 Tympanogram improvement: > 1 month.

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Analysis 2.1

Comparison 2 Improvement (tympanogram or composite), Outcome 1 Improvement composite: 1 month or less.

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Analysis 2.2

Comparison 2 Improvement (tympanogram or composite), Outcome 2 Improvement composite: > 1 month.

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Analysis 2.3

Comparison 2 Improvement (tympanogram or composite), Outcome 3 Improvement composite by intervention: 1 month or less.

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Analysis 2.4

Comparison 2 Improvement (tympanogram or composite), Outcome 4 Improvement composite by intervention: > 1 month.

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Analysis 3.1

Comparison 3 Audiometry Improvement, Outcome 1 Average improvement >= 10 dB in pure tone audiogram (freq. 250 Hz to 2000 Hz).

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Analysis 3.2

Comparison 3 Audiometry Improvement, Outcome 2 Pure tone threshold.

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Table 1. Methodology of included studies

Study	Randomisation method	Groups comparable	Allocation concealed	Ascertainment	Notes
Brooker 1992	Sealed envelope	Not stated	Not used	100%
Stangerup 1992	Consecutively randomised	Yes	Not used	87% at 30 days, 74% at 90 days
Blanshard 1993	Computer generated	Yes	Not used	Over 90% at all outcome points	Intervention group analysed as low and high compliance subgroups
Fraser 1977	Not stated. Three factorial study	Yes	Not used	97%
Lesinskas 2003	Independent person envelopes	Not stated	Not used	100%	Autoinflation performed by the physician
Arick 2005	4 pieces of paper (2 Exp, 2 Control) in a bag, one selected by parent	Yes	Not used	100%	Autoinflation in children performed by parent using modyfied Politzer

Table 1. Methodology of included studies

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Table 2. Side effects and compliance

Trial	Side effects	Compliance
Brooker 1992	None reported	Parents reported good compliance
Stangerup 1992	"We have not observed an increase incidence in middle ear infection or eardrum perforation in connection with autoinflation." No comment given on baseline incidence level.	Compliance at 2 weeks: 33/51 (65%) High compliance, 10/51 (20%) Low compliance, 3/51 ( 6%) No compliance No data given on the other 5 children.
Blanshard 1993	Stratified by compliance level: Attacks of OM 44% control, 36% HC, 30% LC. URTI 61% LC, 32% HC, 23% control Tonsillitis 22% LC, 5% HC, 13% Control Antibiotics 43% LC, 21% HC, 33% control "No complications arose from using the treatment."	45% High compliance(HC), 43% low compliance (LC), 12% unable to use device Some children with OME find doing the Valsalva manoeuvre painful.
Fraser 1977	Some children developed further symptoms and abnormal signs while receiving treatments (do not mention which group)	Not reported
Lesinskas 2003	Treatment ME inflation stopped for 1 adult patient due to painfulness of procedure	100% follow up and compliance (done by physician)
Arick 2005	As part of 1 year follow up 2 children with MEE (hearing restored) 3 children had either grommets inserted and/or enlarged adenoid	Compliance of 97.9% (46/47)

Table 2. Side effects and compliance

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Comparison 1. Tympanometry Improvement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Tympanogram improvement: 1 month or less Show forest plot	3		Relative risk (Random, 95% CI)	Subtotals only

1.1 B or C2 to C1 or A	3		Relative risk (Random, 95% CI)	1.65 [0.49, 5.56]
1.2 B to C1 or A	2		Relative risk (Random, 95% CI)	2.71 [1.43, 5.12]
1.3 C2 to C1 or A	2		Relative risk (Random, 95% CI)	3.84 [1.94, 7.59]
2 Tympanogram improvement: > 1 month Show forest plot	2		Relative Risk (Random, 95% CI)	Subtotals only

2.1 B or C2 to C1 or A	2		Relative Risk (Random, 95% CI)	1.89 [0.77, 4.67]

Comparison 1. Tympanometry Improvement

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Comparison 2. Improvement (tympanogram or composite)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement composite: 1 month or less Show forest plot	4		Relative Risk (Random, 95% CI)	2.47 [0.93, 6.58]

2 Improvement composite: > 1 month Show forest plot	4		Relative Risk (Random, 95% CI)	2.20 [1.71, 2.82]

3 Improvement composite by intervention: 1 month or less Show forest plot	4		Risk Ratio (Random, 95% CI)	2.47 [0.93, 6.58]

3.1 Intervention A ‐Classic Otovent or Carnival blower+balloon	3		Risk Ratio (Random, 95% CI)	1.65 [0.49, 5.55]
3.2 Intervention C ‐ Politzer	1		Risk Ratio (Random, 95% CI)	7.07 [3.70, 13.51]
4 Improvement composite by intervention: > 1 month Show forest plot	4		Risk Ratio (Random, 95% CI)	2.20 [1.71, 2.82]

4.1 Intervention A ‐Classic Otovent or Carnival blower+balloon	2		Risk Ratio (Random, 95% CI)	1.89 [0.77, 4.67]
4.2 Intervention C ‐ Politzer	2		Risk Ratio (Random, 95% CI)	2.25 [1.67, 3.04]

Comparison 2. Improvement (tympanogram or composite)

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Comparison 3. Audiometry Improvement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Average improvement >= 10 dB in pure tone audiogram (freq. 250 Hz to 2000 Hz) Show forest plot	2		Relative Risk (Random, 95% CI)	0.80 [0.22, 2.88]

2 Pure tone threshold Show forest plot	2		Mean difference (Random, 95% CI)	7.02 [‐6.92, 20.96]

Comparison 3. Audiometry Improvement

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Referencias

Referencias de los estudios incluidos en esta revisión

Arick 2005 {published data only}

Blanshard 1993 {published data only}

Brooker 1992 {published data only}

Fraser 1977 {published data only}

Lesinskas 2003 {published data only}

Stangerup 1992 {published data only}

Referencias de los estudios excluidos de esta revisión

Alper 1999 {published data only}

Arick 2000 {published data only}

Blanshard 1995 {published data only}

Chan 1989 {published data only}

Gottschalk 1966 {published data only}

Gottschalk 1991 {published data only}

Hanner 1997 {published data only}

Havas 1995 {published data only}

Kaneko 1997 {published data only}

Kouwen 2005 {published data only}

Kutácová 2005 {published data only}

Leunig 1995 {published data only}

Luntz 1991 {published data only}

Ogawa 2003 {published data only}

Yu 2003 {published data only}

Referencias de los estudios en espera de evaluación

Niebuhr‐Jorgensen {published data only}

Scadding {unpublished data only}

Referencias adicionales

Bluestone 1988

Deeks 2005

Fiellau 1977

Fiellau 1979

Fiellau 1983

Golz 1998

Grace 1990

Hunt‐Williams 1968

Jerger 1970

Lous 1981

Lous 1995

Lous 2005

Reidpath 1999

Rovers 1999

Teele 1989

Thomas 2006

Zielhuis 1989

Zielhuis 1990

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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