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Independents' Day

Watchful waiting better than steroids for glue ear

By Lilian Anekwe

GPs should use a strategy of ‘watchful waiting' for at least one month when managing children with glue ear, a new BMJ analysis concludes.

The findings of the first UK-wide trial of corticosteroids for glue ear in children aged four to eleven found the treatment did not reduce the duration or severity of symptoms when compared to placebo.

Otitis media with effusion is a common chronic problem seen in primary care, for which no effective treatment exists in this setting and which often leads to referral and surgery.

This randomised controlled trial, based in 76 UK general practices, compared a placebo spray with a dose of mometasone furoate 50microgram given daily for three months in 217 children with persistent bilateral otitis media with effusion.

At one month, the proportion of children who were cleared of effusions in at least one ear was 41% in the topical steroid group and 45% in the placebo group.

After three months this proportion had risen to 58% of the topical steroid group, but this was still not significantly different from the 52% of the placebo group whose symptoms had resolved.

At nine months, 56% of the topical steroid group remained clear in at least one ear, but 65% of the placebo group remained clear.

Dr Ian Williamson, senior lecturer in primary care at the University of Southampton and a GP in the city led the research and concluded in the BMJ.

‘This study has shown that when an active monitoring scheme, sometimes called watchful waiting, is used in primary care, almost half of children will spontaneously clear the fluid from at least one of their ears as soon as one month, and thus considerably reduce their risk of disability.'

Dr Williamson told Pulse that although topical steroids were associated with fewer harms the antibiotics and antihistamines, all three had now been shown to be ineffective for glue ear.

‘Half of children with glue in both ears were getting better by as soon as a month naturally, which reinforces the value of at least one month of watchful waiting before referral.

‘The sheer scale of the problem and impact on children's and families lives finding interventions that can be applied in primary care is still a research imperative.'

Otitis media

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