Antibiotics do not prevent asymptomatic glue ear in most children
4 April 2008
Researchers find no statistically significant effect of antibiotic treatment at preventing middle ear effusion.
Otitis media is a condition involving inflammation of the middle ear and is one of the most common problems seen in young children. In the UK, up to 80% of children under the age of four are affected by it at some time. In the form of a middle ear infection, which is often very painful and can include fever and irritability, it is known as acute otitis media (AOM). This can lead to the build-up of a sticky, glue-like fluid in the middle ear, known as middle ear effusion (MEE), which can remain after the infection has gone away. Having MEE can lead to a hearing loss of between 15 and 45dB, because sound cannot be transmitted from the eardrum to the inner ear. MEE is the major symptom of the chronic condition doctors call otitis media with effusion (OME), commonly known as glue ear.
Researchers at the University Medical Center Utrecht in the Netherlands, in collaboration with institutions in the UK, USA and Canada, have recently studied the factors predicting MEE development and the effectiveness of antibiotic treatments for MEE prevention. Laura Coopman and colleagues analysed five MEE studies that included a total of 1,328 children with acute otitis media (AOM) between the ages of 6 months and 12 years. In all studies, the comparison was made between randomised trials of antibiotic treatment for 7-10 days and placebo or no treatment, and MEE had been measured one month after AOM diagnosis.
Results, which were published in the Archives of Otolaryngology – Head and Neck Surgery, showed that the main risk factors for developing MEE were the recurrence of AOM and the child’s age. Children younger than 2 years and those who had repeated bouts of AOM were the most likely to develop MEE. No statistically significant effect of antibiotic treatment at preventing MEE development was found for the group overall. However there was a small beneficial effect in the sub-group of children analysed who were over two years old and without recurrent AOM.
Given the adverse side effects of antibiotics such as nausea, diarrhoea and the build up of antibiotic resistance compared with their small therapeutic benefit, the authors recommend that antibiotics are not prescribed to prevent MEE. This is in line with current treatment guidelines for glue ear. However, the study did not include certain groups for which antibiotic therapy may be of more use, such as children with Down’s Syndrome or cleft palate, and so no conclusions can be drawn for those cases. Further research is needed to determine the efficacy of other anti-microbial treatments such as anti-virals in preventing MEE.
