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Nasal sprays 'of no benefit' in glue ear

Using intranasal steroid sprays to treat glue ear is highly unlikely to be either clinically or cost effective, according to primary care research commissioned by the National Institute for Health Research Health Technology Assessment.

The study involved 217 children with otitis media with effusion (OME) from 76 surgeries. The results suggest a month of intranasal steroid treatment was no more effective - and possibly even less effective - than placebo.

There have been suggestions that intranasal steroids may reduce inflammation and help clear effusions more quickly but data from large trials have been lacking - leading to this primary care-based trial.

Children were randomised to receive either a topical steroid, mometasone furoate, or a placebo spray once daily in each nostril for three months.

Overall it found steroid therapy was actually associated with a lower reduction in risk than placebo. And although children with more severe OME did appear to benefit from steroid therapy, it was less cost-effective than placebo due to the higher costs per patient when comparing improvements in a combined measure of quantity and quality of life.

Dr Ian Williamson - senior lecturer in primary care at the University of Southampton – was lead author of the study. ‘Although our results indicate that the use of topical mometasone is not likely to be clinically or cost-effective for treating glue ear in primary care, the trial provides a structured management system for treating OME,' he said.

‘As most cases of OME will resolve spontaneously it is important to identify those small groups of patients who may benefit from steroid therapy.'

Further research should concentrate on secondary care and targeted populations only – such as children with moderate to severe allergies - or as an alternative to reinsertion of grommets in older children, he added.

Dr Alex Watson, a GP in Surrey and author of the book ‘ENT in primary care', said nasal steroids were suitable for some children, but most would get better with time.

‘Watchful waiting for three months is what I would recommend, but a lot of children with glue ear have chronic rhinitis and in carefully selected patients you should consider the use of nasal steroids,' he said.

Key findings

• Research showed no difference in the rate of children getting better from glue ear irrespective of whether they were given a topical steroid or in a dummy group using placebo.

• The absolute risk reduction in the treated group at 1 month was actually worse than in the placebo group

• Based on the data it found at least 11 children would require to be treated for 1 month with nasal steroids for one child to potentially benefit

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