Aggressive and ineffective therapy for otitis media

Objective: The standard American clinical practice for the management of acute otitis media (AOM), otitis media with effusion (OME), and recurrent otitis media (ROM) calls for repeated courses of wide-spectrum antibiotic therapy including extended duration antibiotic prophylaxis, followed by surgical insertion of typanostomy tubes with or without adenoidectomy. This is an attempt to assemble the scientific evidence to justify this practice. Methods: A systematic review of the literature involving clinical studies, randomized clinical trials (RCTs), and meta-analyses to summarize the existing database. Results: For the efficacy of antibiotics for AOM, only 3 of the 13 clinical studies and RCTs had positive results with marginal benefits. Among the 16 RCTs on the effectiveness of antibiotics for OME involving 2,067 children, 8 RCTs with placebo controls had pooled average antibiotic efficacy of 4% or less. Pooled data from 13 RCTs on antibiotic prophylaxis, ranging in duration 1 week to 2 years, for ROM provided no significant clinical prevention (less than 0.4 episodes per year). The surgery, based on the outcome of 22 RCTs, is not shown to be effective with the exception of extreme disease cases. In fact, it is estimated that over 90% of surgical cases for otitis media in the US are unnecessary. Conclusions: A scientific database is lacking to support the present American clinical practice of aggressive interventions. It is not an evidence-based medical practice that yields patient benefits. Rather, it is an unnecessary intervention with compelling adverse effects to the patient and the community.