Research Investigates Use Of Nasal Steroids To Treat Glue Ear In Primary Care

Main Category: Ear, Nose and Throat
Also Included In: Primary Care / General Practice
Article Date: 08 Sep 2009 - 0:00 PDT

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Research commissioned by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has found that the treatment of glue ear with a nasal steroid is not clinically or cost-effective in the primary care setting. Glue ear, or otitis media with effusion (OME), is a common and disabling condition in children for which there is currently no proven effective medical treatment.

OME is caused by the accumulation of fluid in the middle ear and can result in loss of hearing, delayed language development and behavioural problems. The presence of OME in both ears is associated with greater disability. The condition generally affects young children and although most cases improve without treatment it is the most common cause of referral for surgery in this age group. Intra-nasal steroids have been considered as a potential therapy to treat the condition as they reduce inflammation and may aid fluid clearance from the ear.

The study, led by Dr Ian Williamson, recruited 217 children aged 4-11 years from 76 general practice surgeries. All children had persistent (longer than three months) and confirmed OME in both ears. Children were randomised to receive either a topical steroid, mometasone furoate, or a placebo spray once daily in each nostril for three months.

The results showed that one month of intra-nasal steroid treatment was no more effective than placebo for curing OME. Overall, the steroid therapy was associated with a lower reduction in risk than the placebo. This effect remained until the nine-month follow up. However, children with more severe OME did appear to benefit from steroid therapy.

Steroid therapy was also found to be less cost-effective than placebo as it was associated with higher costs per patient when comparing improvements in the combined measure of quantity and quality of life.

"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," says Dr Ian Williamson. "As most cases of OME will resolve spontaneously it is important to identify those small groups of patients who may benefit from steroid therapy."

The full results of this study have published in Health Technol Assess 2009; Vol 13:37, visit http://www.hta.ac.uk/project/1352

Source
National Institute for Health Research

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