A Cochrane review [Abstract] 1 included 12 studies (9 on oral and 3 on topical intranasal steroids) with a total of 945 subjects. No study prospectively documented hearing loss prior to randomisation. Follow up was mainly short term. There was no evidence of benefit from steroid treatment (oral or topical) in terms of hearing loss associated with otitis media with effusion (OME) (oral steroids versus control RR 1.09, 95% CI 0.80 to 1.49; 1 study, n=44; oral steroids plus antibiotic versus control plus antibiotic RR 1.01, 95% CI 0.73 to 1.40; 1 study, n=99). Pooled data for OME resolution at short-term follow up (< 1 month) showed a significant effect of oral steroids compared to control (RR 4.48, 95% CI 1.52 to 13.23; fixed-effect model). However, the result was not more statistically significant when using random-effects model (RR 3.80, 95% CI 0.93 to 15.52; 3 studies, n=108). Oral steroids plus antibiotic also resulted in an improvement in OME resolution compared to placebo plus antibiotic at less than one month follow up (RR 1.99, 95% CI 1.14 to 3.49, statistical heterogeneity I² = 69%; 5 studies, n= 409). There was no evidence of beneficial effect on OME resolution at greater than one month follow up with oral steroids (used alone or with antibiotics) or intranasal steroids (used alone or with antibiotics) at any follow-up period. There was also no evidence of benefit from steroid treatment (oral or topical) in terms of symptoms.
Comment: The quality of evidence is downgraded by indirectness (lack of long-term results) and by imprecise results (limited study size for each comparison).
Primary/Secondary Keywords