ANTIBIOTICS VS. VENTILATION TUBES FOR OTITIS WITH EFFUSION

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ANTIBIOTICS VS. VENTILATION TUBES FOR OTITIS WITH EFFUSION.

The treatment of otitis media with effusion in children is controversial. Two common modalities include long-term prophylactic antibiotics and surgical placement of ventilation tubes. This randomized, controlled trial involving 125 children compares both approaches and finds that there is no clear winner.

The children, two to seven years old, had documented middle ear fluid for at least three months with mild conductive hearing loss. They were treated with either tube insertion or sulfisoxazole (75 mg/kg twice daily for six months). Overall, effusion resolved in a significantly greater number of children with tubes than with antibiotic therapy (52 percent vs. 33 percent). Children with tubes had significantly better hearing at two and four months, but not at six, 12, or 18 months. There were no differences between groups with regard to new episodes of acute otitis media. Four children had possible allergic rashes from sulfisoxazole, but tube placement led to significantly more complications.

One-third of the sulfa-treated children had a resolution of effusion, without the expense and possible complications of tube placement, and hearing was comparable over the long term in the two groups. Thus, the authors argue that in children with less than a 40-decibel hearing loss or without a language delay, the most prudent course is to conduct a six-month trial of antimicrobial therapy before considering tube placement.

— RAD

Published in Journal Watch General Medicine August 16, 1991

Citation(s):

Bernard PAM et al. Randomized, controlled trial comparing long-term sulfonamide therapy to ventilation tubes for otitis media with effusion. Pediatrics 1991 Aug 88 215-222.