Nonsurgical home treatment of middle ear effusion and associated hearing loss in children. Part I: clinical trial. Autoinflation in the treatment of glue ear in children. Conservative treatment of otitis media with effusion by autoinflation of the middle ear. Autoinflation as a treatment of secretory otitis media. A randomized controlled study. Factors affecting the results of nonsurgical treatment of secretory otitis media in adults. The medical treatment of secretory otitis media. A clinical trial of three commonly used regimes.
We conducted a randomized, controlled clinical trial to investigate the efficacy of treatment of persistent middle ear effusion (MEE) and associated hearing loss with a modified Politzer device used in the home setting over a 7-week period. Efficacy was determined by comparing pre-and posttherapy air-conduction thresholds, tympanometric peak pressures, and otoscopic findings. The study group was made up of 94 children (174 ears), aged 4 to 11 years, who had at least a 2-month history of MEE and associated hearing loss. At study's end, patients in the treatment group experienced statistically significant improvements in all measured outcomes; no significant improvements were seen in the control group in all measured outcomes. At study's end, the hearing sensitivity of 73.9% of the treated ears was within normal limits, compared with only 26.7% of the control ears. These findings demonstrate that home treatment of children with persistent MEE and associated hearing loss with the modified Politzer device is highly efficacious. The use of autoinflation in the treatment of glue ear has been widely recommended. In order to assess its efficacy, 40 children were studied. 21 children practised nasal autoinflation of a toy balloon 3 times daily for 3 weeks and 19 children had no treatment. In the autoinflation group only 4 glue ears improved, while in the untreated group 10 glue ears improved. This study suggests that autoinflation has no part to play in the treatment of glue ear in children. A total of 85 children on the waiting list for grommet insertion aged between 3 and 10 years with bilateral chronic otitis media with effusion (OME) were assigned at random to an observation or treatment group. Those in the treatment group were given the Otovent device to use three times a day for the duration of the study and both groups were then seen at monthly intervals for 3 months for pneumatic otoscopy and tympanometry. Statistically significant improvement was seen in those using the treatment with a compliance of more than 70%. This was detected on the outcome measures of tympanometry and pneumatic otoscopy after 1, 2 and 3 months. No side effects were demonstrated. We conclude that autoinflation is an effective short-term treatment for children with OME when used regularly under supervision. This study was undertaken to evaluate the effect of a new method of autoinflation as an alternative treatment of secretory otitis media. Up to 80% of all children experience one or more episodes of eustachian tube dysfunction and secretory otitis media before school age. Common treatment of this condition is insertion of a ventilation tube in the tympanic membrane. Because of the very high incidence of secretory otitis media in childhood, insertion of ventilation tubes is the most frequently performed operation under general anesthesia in children. In addition to possible anesthetic complications, insertion of ventilation tubes may be associated with purulent suppuration, pathologic findings in the eardrum, and hearing impairment. One hundred children were consecutively randomized to undergo either autoinflation, using a new device, or placed in a control group. The children were between 3 and 10 years of age and were entered into the study after having had secretory otitis media for at least 3 months, as verified by tympanometric findings. Tympanometry was repeated at 2 weeks and at 1, 2, and 3 months after the children were entered into the study. After 2 weeks of autoinflation, the tympanometric conditions were improved in 64% of ears, unchanged in 34%, and deteriorated in the remaining 2%. In the control group, tympanometric findings were improved in 15% of ears, unchanged in 71%, and deteriorated in the remaining 14%. There is only limited knowledge of the factors influencing the results of nonsurgical treatment of secretory otitis media (SOM) in adults. The present study was carried out to determine the effect of the middle ear (ME) inflation and to clear up the factors affecting the results of conservative treatment of SOM.
                A total of 198 adult patients were randomized to either a group receiving treatment with ME inflation for 10 days or to a group receiving ME inflation and antibiotics (oral Amoxicillin 500 mg 3/day) for 10 days or to a control group. A wide variety of anamnestic and clinical pre-treatment variables were assessed by administered questionnaires. Pneumo-otoscopy, tympanometry and pure-tone audiometry were performed before the treatment and at the 3-5th, 10th+/-2 and 60th+/-5 day of the study. For the prognostic factors, univariate analyses were first performed to determine the significant predictors, which were afterwards entered into a stepwise logistic regression model.
                The effectiveness of treatment was 50.6% in Group A and 58.7% in Group B (control group-11%, P<0.001). The results of treatment were stable and were found unchanged 6 weeks after the treatment. The most important prognostic criteria were defined by analyzing the dynamics of tympanometry (OR, 2.17) and audiometry (OR, 10.27) during conservative treatment. The results of the treatment were related to the mastoid pneumatization, the pathology of paranasal sinuses, the previous history of SOM, the age, and the pre-treatment otoscopic data.
                The results suggest, that daily ME inflation can be effective treatment for adults patients with SOM having regard to the factors significant for the prognosis of treatment. A clinical trial was undertaken to evaluate three medical treatments commonly used for chronic secretory otitis media. The treatments compared were Ephedrine nose drops, an oral antihistamine and decongestant (Dimotapp) and autoinflation of the middle ear. Changes in middle ear compliance and pressure were used as objective criteria of the efficacy of treatment in addition to changes in pure-tone threshold and to clinical assessment. Symptoms and abnormal signs tended to remit during the trial but there was no evidence from pure-tone audiometry and tympanometry that any of the treatments was beneficial. The period of observation enabled 28% of the children to avoid surgical treatment. Good and bad prognostic features are described which should help in deciding whether to manage a case conservatively or whether to proceed directly to surgery.
All of the studies were small, of limited treatment duration and had short follow-up. However, because of the low cost and absence of adverse effects it is reasonable to consider autoinflation whilst awaiting natural resolution of otitis media with effusion. Primary care could prove a beneficial place to evaluate such interventions and there is ongoing research in this area. Further research should also consider the duration of treatment, the long-term impact on developmental outcomes in children and additional quality of life outcome measures for children and families.