Topical steroids have fewer adverse effects because of minimal systemic absorption. Twelve randomized controlled trials comparing oral or topical nasal steroids with or without antibiotics with placebo were included in this analysis. Children up to 12 years of age were included. Hearing loss was the primary outcome of interest; secondary outcomes included time to resolution of effusion and symptoms. Three studies reported audiometry data from follow-up visits.
One study compared oral steroids with placebo, and another compared oral steroids plus antibiotics with placebo. Neither study showed statistically significant differences between groups with regard to hearing loss. A third study comparing topical steroids with placebo showed no significant difference in the median number of days of hearing loss. All 12 studies evaluated resolution of effusion. Two studies comparing oral steroids with placebo did not show a significant effect at short-term or intermediate-term follow-up.
In five of six studies evaluating oral steroids plus antibiotics versus antibiotics alone, the children in the steroid group showed significantly greater resolution of effusion at follow-up visits after seven to 28 days. Studies of topical nasal steroids showed no improvement in resolution of effusion versus the control group.
Adverse effects, including diarrhea, increased appetite, and hyperactivity, were reported in five of the oral steroid studies and three of the topical nasal steroid studies. In one study that compared oral steroids with antibiotics and placebo with antibiotics, five of children dropped out of the study because of adverse effects; none of the adverse effects appeared to be related to steroid use.
Oral steroids lead to faster resolution of otitis media with effusion but do not affect symptoms or hearing outcomes. Given the cost and potential adverse effects of steroids, their use in otitis media with effusion is not warranted. Already a member or subscriber? Log in. Address correspondence to Dean A. Reprints are not available from the authors. The views expressed in this article are those of the authors and do not reflect the official policy or position of the U.
Otitis media with effusion. A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to year-old children with persistent bilateral otitis media with effusion in primary care. Health Technol Assess. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. Systemic steroid for chronic otitis media with effusion in children. The Cochrane Abstract is a summary of a review from the Cochrane Library.
It is accompanied by an interpretation that will help clinicians put evidence into practice. Seehusen and MacDonnell present a clinical scenario and question based on the Cochrane Abstract, followed by an evidence-based answer and a critique of the review. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Feb 1, Issue. Clinical Scenario A mother brings her five-year-old son to your clinic because of several days of decreased hearing in his right ear following a mild upper respiratory tract infection.
Clinical Question Do oral or topical nasal steroids improve short- or long-term outcomes of children who have otitis media with effusion? Evidence-Based Answer Oral steroid use, alone or in combination with antibiotics, speeds the resolution of otitis media with effusion. Cochrane Abstract Background: Otitis media with effusion is common and may cause hearing loss with associated developmental delay. Practice Pointers Otitis media with effusion, a noninflammatory condition characterized by fluid in the middle ear, is common in young children.
Read the full article. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If your condition does not improve within 5 to 7 days, or if it becomes worse, check with your doctor.
While you are being treated with otic corticosteroids, and after you stop treatment, do not have any immunizations vaccinations without your doctor's approval. Otic corticosteroids may lower your body's resistance and there is a chance you might get the infection the immunization is trying to prevent. In addition, other persons living in your household should not take or have recently taken oral polio vaccine since there is a chance they could pass the polio virus on to you.
Also, avoid other persons who have taken oral polio vaccine. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.
Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
I take a course of prednisone a couple of times a year to combat vertigo, which accompanies the disease. It all started as you described- a head cold and clogged ears. Coming out of anesthesia he could not hear in his good ear. He lost hearing in the right ear due to an auto immune disease 10 years prior. The surgeon did permit 5 mg. Currently he can't hear up to decibels in the left ear, but in the previously deaf ear he can hear up to 85 decibels.
We are hoping that a stronger round of Prednisone will help him. Thank you! After my second injection on October 26, , I could actually hear words - faint words, but words. I had my 3rd and final injection on November 2, I am just today finishing up my last prednisone pill. Hi, I just went to an ENT ear spec last week and am also going to have an mri next week. I have had tinnitus my whole life and it never really occurred to me to have it checked cause I'm so used to it, but I've been having hearing loss on and off for sev.
ANYWAY, the good news for you is that he told me bilateral tinnitus like yours possibly is a better prognosis. He did check her throat and chest, said they were clear. She has not been tested for asthma. As for the prednisone, the first time, and this time it's for 4 days each. I think when she finishes the prednisone this time, I will go back to the pseudophedrine.
I have vicks rub. Thanks for replying. Still no better today, still dizzy and have opaque fluid in my ears as can be seen by an otoscope. I have been doing VRT for three weeks due to the dizziness, but without any results.
I would like to call my doc again, but at this point I do not even know what can be done. I tried to get in with an ENT, but am looking at a three month wait at this point. Any advice would be helpful. I started getting a severe pain deep in my ear with an ungoddly itch that felt like it was in my throat and deep in my skull.
A severe pain in the back of my head more towards the right side but in the middle. Some numbness below my jawline on both sides of face. A feeling that my face was about to cave in, Vertigo that would keep me in bed for days. And very hard crystal looking discharging from my ear. Hi, I am having some partial hearing loss in my left ear for the past 4 weeks. I am taking hypothyroid meds. I have consulted ENT doc and they prescribed prednisolone, methylcobalamin inj.
From last week, I have seen some improvement but not at all cure. I felt some inbalance while walking and still there is some ringing sounds. I want to know whether my hearing problem will be a permanent or not. I want to hear any advice regarding my problem. MY left ear, long considered useless, opened up I felt a trickle in the back of my throat.
Oregano oil is purported to be a anti-fungal, anti-bacterial, anti-viral and anti parasite herb. I have not been consistent with taking it and I feel foolish about that. The problem in my right ear began on a plane flight, I heard a crackle and my ear hurt. However, you cannot use them if you have fluid in ear. Do discuss this with your doctor and get yourself examined. Take care! They said that I have a ear infection.
They gave me antibiotics an ear drops that are used for swimmers ear. I could not buy the other ear drops that they gave me. The pain was horrible last night. I took some tylenal an it helped a little. Dose any one know of any thing that I can take. I can feel my heart beat an fluid behind my ear. Please help. Its driving me crazy. I can't find anything else to try that doesn't sound ridiculous.
I am open to any suggestions. The fluid is driving me nuts and I can't hear. In the outer ears cerumen impaction or external otitis, in the middle ear fluid collection or disease of the tympanic membrane and in the inner ear damage to the nerve endings can cause hearing loss.
Treatment lies in treating the underlying cause. Hope this helped and do keep us posted. Do you have to have ear infection to get fluid in the mastoid bone If you remain with poor hearing in the ear but have good hearing in the other ear , you can eventually get a CROS hearing aid, a TransEar, or a Baha bone-anchored hearing aid. I have a Baha and love it. At this point there is probably nothing you can do except wait and see if you recover any more hearing. Good luck! Physio said that he can try to help my Vertigo if it's from inner ear I told him I went to two ENT a few years ago and they tested me with water in the ears etc..
He said if Prednisone helps stop the Vertigo then it's not inner ear.. That can often be the hard part. Most commonly, associated with inflammation secondary to viral infections, allergic inflammation, irritants cigarette smoke. There are rarer and more serious causes, like I mentioned. There I was diagnosed with bronchitis and given a Z-Pac antibiotic, a Proventil inhaler, albuterol in a nebulizer and prednisone tablets. After finishing these medications I felt slightly better but still very weak, achy, no energy.
I returned to my regular dr on the next visit and rales were heard in my chest with ear pain, headaches. My diagnosis was then bronchitis that turned into pneumonia, double ear infection, sinus infection. This will usually make it possible for the fluid to drain into the back of the throat. Fluid in the ears may or may not cause symptoms.
In fact, in almost half of all cases of otitis media with effusion there are no signs or symptoms reported by the child or their caregivers. If symptoms do occur, they can include mild ear pain that comes and goes, hearing loss, delayed development in speech and language skills, delayed gross motor skills and balance problems vertigo.
For information on conditions that cause similar symptoms to fluid in the ear or that may be present at the same time as fluid in the ear you may wish to read some of the following articles:. The best method for diagnosing fluid in the ear is examination of the ear using an otoscope or otomicroscopy. This procedure is very simple and involves pulling back the ear and inserting the tip of the otoscope into the ear.
This allows the doctor to visualize the ear drum tympanic membrane. Experienced physicians may actually see either a fluid level behind the ear drum, a bubble, or that the ear drum is immobile. Unfortunately, it is not always so clear and the only thing indicating fluid in the ear might be a slight retraction of the ear drum, or a slightly abnormal coloration.
A study suggests otomicroscopy to be superior to the use of a regular otoscope but many doctors do not have access to this equipment. The presence of fluid in the ear can be confirmed by another test called tympanometry. This test has some similarities to an exam using an otoscope in that the ear will be pulled back and the tip of the instrument, also called the speculum, will be placed in the outer portion of the ear canal.
The instrument will measure the pressure inside of the ear then generate a tone. The tympanic membrane will reflect a certain amount of sound back into the tympanometer, which is charted on a graph called a tympanogram. If there is fluid in the ear, the tympanic membrane will stiffen and an abnormal amount of sound will be reflected. Because fluid in the ear is often asymptomatic, especially in children, it often goes undiagnosed.
If your child has symptoms of fluid in the ear it is best to take them to a pediatricians or an otolaryngologist ear, nose, throat specialist or ENT.