Grommets effective for recurrent otitis media
By Lilian Anekwe
GPs should consider referring children with recurrent otitis media for insertion of grommets, experts have advised, after a gold standard review found the treatment was safe and effective.
Cochrane researchers found the treatment reduced recurrent episodes and was significantly more effective than use of antibiotics.
Grommets are more commonly used as a treatment option for patients with glue ear because of a lack of evidence for their use in treatment of recurring ear infections.
But a comparison of the efficacy of grommets with either antibiotics or no treatment for recurrent otitis media found they reduced frequency of infection and the proportion of children with symptoms of ear infection.
The review, of two randomised controlled trials involving 148 children, showed surgically inserting grommets gave an average reduction of 1.5 episodes of acute otitis media in the first six months after treatment.
Both studies showed a significant increase in the proportion of children with no episodes in those fitted with a grommet in the six months after treatment, although the difference was not significant in the smaller trial of 53 children. In both studies, no adverse events were reported in children with grommets.
Study leader Dr Stephen McDonald, part of the Cochrane ear, nose and throat disorders group, concluded: ‘In children of three years and under with recurrent acute otitis media, ventilation tubes reduce episodes in the first six months after surgery.
‘The effect size is small in terms of number of episodes but in both studies more than 50% of children were free of episodes after grommet insertion while no more than a handful were rendered episode-free in the antibiotic arm.'
Dr Prakash Shah, a GPSI in ENT in Balham, south London, said: ‘Recurrent acute otitis media is one of the commonest conditions I see but I very rarely think of referring a patient for grommets, because there's a perception – and I could be wrong – that they could cause bleeding or other complications.‘
Mrs Clair Langton Hewer, an ENT consultant at St. Michael's hospital in Bristol, said the study meant GPs should consider referring children with recurrent acute otitis media for surgery earlier.
‘As an ENT specialist I have always been aware grommets are used for glue ear and recurrent otitis media, but I'm not sure a GP would always consider referral at an early stage – but this study suggests they should.'Otitis media