Inflammation is considered an important factor in the pathogenesis and continuation of otitis media with effusion. Theoretically, this may support the use of steroids, oral or intranasal in the management of this condition. This study comprised three well matched groups of 97-98 children. In group A, oral prednisolone was followed by intranasal mometasone. In group B, only oral prednisolone was administered and in group C, children received no treatment (watchful waiting). Unlike in some past studies, a stricter assessment involving conversion of type B and C 1,2 tympanograms to type A and hearing improvement by 20dB was applied in follow up appointments at six weeks, three months, six months and nine months.

A statistically significant improvement was observed in children receiving oral steroids and intranasal spray at six weeks and three-month follow-ups but in the long term (nine months) this did not differ from the outcome of watchful waiting.

There was no statistically significant difference between the use of oral prednisolone alone (group B) or with intranasal steroid spray following it (group A). The study also failed to show any significant improvement between six months and nine months in any of the three study groups, suggesting that follow-ups after six months will not be rewarded with an improvement. Therefore, other modalities, such as surgery should be considered in the treatment of otitis media with effusion at this time. However, it was noted that if one ear improved, the other followed course, justifying further wait. The use of oral steroids in this early age group of 2-11 years could be rather venturesome and thankfully this study supports the view of the American Academy of Otolaryngology-Head and Neck Surgery which does not advise it.

Oral steroids alone or followed by intranasal steroids versus watchful waiting in the management of otitis media with effusion.
Hussein A, Fathy H, Amin SM, Elsisy N.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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