American Speech-Language-Hearing Association

EBP Compendium: Summary of Systematic Review

NHS Wales Office for Research and Development for Health and Social Care; the WT Grant Foundation
Does Early Detection of Otitis Media with Effusion Prevent Delayed Language Development?

Butler, C. C., & MacMillan, H. (2001).
Archives of Disease in Childhood, 85(2), 96-103.

Indicators of Review Quality:

The review addresses a clearly focused question Yes
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible No

Description: This is a review of articles, clinical trials and meta-analyses dealing with otitis media with effusion (OME) and language delay in children. 

Question(s) Addressed:

  1. Is screening children within their first 4 years for OME effective in preventing delayed language development?
  2. Is there a suitable screening tool for early detection of OME?
  3. Is treatment effective in clearing effusions?
  4. Does treating OME improve language-related outcomes?
  5. Is there an association between OME and delayed language development?

Population: Children up to 4 years.

Intervention/Assessment:

  • Detection Tools:
    • Hearing tests
    • Tympanometry
    • Acoustic reflectometry
    • Pneumatic otoscopy
  • Treatments:
    • Mucoactive drugs
    • Antibiotics
    • Steroids
    • Surgery
    • Auto-inflation
    • Non-steroidal, anti-inflammatory drugs
    • Homeopathic treatments
    • Antihistamines

Number of Studies Included: Not stated

Years Included: 1966 - 2000

Findings:

Conclusions:

  • Screening/Assessment
    • General Findings
      • "There is insufficient evidence to recommend early detection of OME in children in the first 4 years of life to prevent delayed language development" (p. 101).
    • Assessment Instruments
      • Tympanometry, Microtympanometry, Acoustic Reflectometry & Pneumatic Otoscopy - "On the basis of these findings we conclude that there is insufficient evidence to make recommendations for or against the use of tympanometry, microtympanometry, acoustic reflectometry, and pneumatic otoscopy for the earlier detection of OME in the general population of children up to 4 years of age" (p. 101).
  • Management
    • Speech and Language
      • General Findings - "Most prospective cohort studies that evaluated the association between OME and language development lacked adequate measurement of exposure or outcomes, or suffered from attrition bias. Findings with regard to the association were inconsistent" (p. 96).
      • Grommets/Ventilation Tubes - In children with hearing loss associated with OME, "There is good evidence that treatment of OME with ventilation tubes compared with watchful waiting improves language outcomes at 9 months...However, by 18 months, differences were no longer apparent" (p. 100).
      • Watchful Waiting - "There is good evidence that treatment of OME with ventilation tubes compared with watchful waiting improves language outcomes at 9 months...However, by 18 months, differences were no longer apparent" (p. 100).
    • Hearing
      • Grommets/Ventilation Tubes - "Ventilation tubes resolved effusions and improved hearing" (p. 96).
      • Antibiotics - "Evidence of benefit in the short and medium term must be considered in the context of risking bacterial resistance, side effects, and lack of evidence for long-term improvement in children with OME" (p. 100). 

Keywords: Otitis Media

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Added to Compendium: December 2011

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