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Oral steroids for hearing loss associated with otitis media with effusion in children aged 2 8 years: the OSTRICH RCT

Francis, N. A., Waldron, C., Cannings-John, R., Thomas-Jones, E., Winfield, T., Shepherd, V., Harris, D., Hood, K., Fitzsimmons, D., Roberts, A., Powell, C. V., Gal, M., Jones, S. and Butler, C. C. 2018. Oral steroids for hearing loss associated with otitis media with effusion in children aged 2 8 years: the OSTRICH RCT. Health Technology Assessment 22 (61) 10.3310/hta22610

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Abstract

Background Children with hearing loss associated with otitis media with effusion (OME) are commonly managed through surgical intervention, hearing aids or watchful waiting. A safe, inexpensive, effective medical treatment would enhance treatment options. Small, poorly conducted trials have found a short-term benefit from oral steroids. Objective To determine the clinical effectiveness and cost-effectiveness of a 7-day course of oral steroids in improving hearing at 5 weeks in children with persistent OME symptoms and current bilateral OME and hearing loss demonstrated by audiometry. Design Double-blind, individually randomised, placebo-controlled trial. Setting Ear, nose and throat outpatient or paediatric audiology and audiovestibular medicine clinics in Wales and England. Participants Children aged 2–8 years, with symptoms of hearing loss attributable to OME for at least 3 months, a diagnosis of bilateral OME made on the day of recruitment and audiometry-confirmed hearing loss. Interventions A 7-day course of oral soluble prednisolone, as a single daily dose of 20 mg for children aged 2–5 years or 30 mg for 6- to 8-year-olds, or matched placebo. Main outcome measures Acceptable hearing at 5 weeks from randomisation. Secondary outcomes comprised acceptable hearing at 6 and 12 months, tympanometry, otoscopic findings, health-care consultations related to OME and other resource use, proportion of children who had ventilation tube (grommet) surgery at 6 and 12 months, adverse effects, symptoms, functional health status, health-related quality of life, short- and longer-term cost-effectiveness. Results A total of 389 children were randomised. Satisfactory hearing at 5 weeks was achieved by 39.9% and 32.8% in the oral steroid and placebo groups, respectively (absolute difference of 7.1%, 95% confidence interval –2.8% to 16.8%; number needed to treat = 14). This difference was not statistically significant. The secondary outcomes were consistent with the picture of a small or no benefit, and we found no subgroups that achieved a meaningful benefit from oral steroids. The economic analysis showed that treatment with oral steroids was more expensive and accrued fewer quality-adjusted life-years than treatment as usual. However, the differences were small and not statistically significant, and the sensitivity analyses demonstrated large variation in the results. Conclusions OME in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. Discussions about watchful waiting and other interventions will be enhanced by this evidence. The findings of this study suggest that any benefit from a short course of oral steroids for OME is likely to be small and of questionable clinical significance, and that the treatment is unlikely to be cost-effective and, therefore, their use cannot be recommended.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: NIHR Journals Library
ISSN: 1366-5278
Date of First Compliant Deposit: 21 November 2018
Date of Acceptance: 30 April 2018
Last Modified: 11 Jun 2020 10:00
URI: http://orca-mwe.cf.ac.uk/id/eprint/116833

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