A randomised controlled trial of surgery for glue ear. Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets). Grommets and Glue Ear: A Five-Year Follow up of a Controlled Trial 1 A prospective randomized trial of adenoidectomy vs grommet insertion in the treatment of glue ear. OTOSCOPIC, IMPEDANCE, AND AUDIOMETRIC FINDINGS IN GLUE EAR TREATED BY ADENOIDECTOMY AND TONSILLECTOMY: A Prospective Randomised Study Improving referrals for glue ear from primary care: are multiple interventions better than one alone? The effectiveness of adenoidectomy in the treatment of glue ear: a randomized controlled trial. Surgery for persistent otitis media with effusion: generalizability of results from the UK trial (TARGET). Trial of Alternative Regimens in Glue Ear Treatment. A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care. A randomized comparison of homoeopathic and standard care for the treatment of glue ear in children. A prospective trial of unilateral grommets for bilateral secretory otitis media in children. A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment. Naturopathic treatment for ear pain in children. Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media. Randomised controlled trial of early surgery versus watchful waiting for glue ear: the effect on behavioural problems in pre-school children. Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study. Topical Ciprofloxin Versus Topical Framycetin-Gramicidin-Dexamethasone in Australian Aboriginal Children With Recently Treated Chronic Suppurative Otitis Media: A Randomized Controlled Trial
OBJECTIVE --To assess the effect of five different surgical treatments for glue ear ( secretory otitis media ) on improvement in hearing and , assuming one or more treatments to be effective , to identify the appropriate indications for surgery . DESIGN --R and omised controlled trial of children receiving ( a ) adenoidectomy , bilateral myringotomy , and insertion of a unilateral grommet ; ( b ) adenoidectomy , unilateral myringotomy , and insertion of a unilateral grommet ; ( c ) bilateral myringotomy and insertion of a unilateral grommet ; and ( d ) unilateral myringotomy and insertion of a grommet .  Children were followed up at seven weeks , six months , 12 months , and 24 months by symptom history and clinical investigations . SETTING --Otolaryngology department in an urban hospital . PATIENTS --149 Children aged 4 - 9 years who were admitted for surgery for glue ear and who had no history of previous operations on tonsils , adenoids , or ears and no evidence of sensorineural deafness . Inadequate follow up information on levels of hearing and on middle ear function was obtained from 22 . MAIN OUTCOME MEASURES --Mean hearing loss ( dB ) of the three worst heard frequencies between 250 and 4000 Hz , results of impedance tympanometry , and parental views on their child 's progress . RESULTS --In the 127 children for whom adequate information was available ears in which a grommet had been inserted performed better in the short term ( for at least six months ) than those in which no grommet had been inserted , irrespective of any accompanying procedure . Most of the benefit had disappeared by 12 months . Adenoidectomy produced a slight improvement that was not significant , though was sustained for at least two years . The ears of children who had had an  adenoidectomy  with myringotomy and grommet insertion , however , continued to improve so that two years after surgery about 50 % had abnormal tympanometry compared with 83 % of those who had had only myringotomy and grommet insertion , and 93 % of the group that had had no treatment . Logistic regression analyses identified preoperative hearing level as the single best predictor of good outcome from surgery . Other variables contributed little additional predictive power . CONCLUSIONS --If the principal objective of surgery for glue ear is to restore hearing then our study shows that insertion of grommets is the treatment of choice . The addition of an adenoidectomy will increase the likelihood of restoration of normal function of the middle ear but will not improve hearing . When deciding appropriate indications for surgery , a balance has to be made between performing unnecessary operations and failing to treat patients who might benefit from surgical intervention . Preoperative audiometry scores might be the best predictor in helping to make this decision OBJECTIVE --To measure the time to spontaneous resolution of severe chronic otitis media with effusion ( glue ear ) in children and study the effects of adenoidectomy , adenotonsillectomy , and ventilation tubes ( grommets ) . DESIGN --R and omised controlled study over 12 years . SETTING --Paediatric otorhinolaryngology clinics and in-patient unit . SUBJECTS--228 children aged 2 - 9 years with pronounced hearing loss from glue ear and persistent bilateral middle ear effusions confirmed on three occasions over three months . INTERVENTIONS --Children were r and omly allocated to adenotonsillectomy , adenoidectomy , or neither procedure . In all groups a Shepard type ventilation tube was inserted in one r and omly chosen ear . Follow up was annually for five years and then less often for up to seven years four months . For analysis the two operated groups were combined . MAIN OUTCOME MEASURES --Otoscopic clearance of fluid , change in tympanogram , and improvement in mean audiometric hearing threshold . RESULTS --Survival analysis showed appreciable otoscopic and tympanometric resolution of fluid with ventilation tubes alone and adenoidectomy alone compared with no surgery . Further improvement was seen after combination of both treatments . Mean audiometric hearing thresholds improved with fluid resolution . Resolution was delayed in younger children and in those whose parents smoked , irrespective of treatment . Whereas a single insertion of a Shepard tube resolved the glue for a mean ( SD ) period of 9.5 ( 5.2 ) months , the effect of adenoidectomy was sustained throughout follow up . CONCLUSIONS --Treatment of glue ear considerably shortened the time to fluid resolution , combined adenoidectomy and tube insertion being better than either procedure alone . Resolution was longer in younger children and those whose parent(s ) smoked , irrespective of treatment Material and methods Sixty children aged between 4 and 10 years with seromucinous otitis media in both ears were originally included , but 5 failed to attend for follow up , thus leaving a total of 55 ( 92 % followup rate ) . In each instance the diagnosis was made on a careful history , otoscopy and pure tone audiometry . Under a general anaesthetic both ears were inspected with the microscope , and at r and om selection only one ear was drained and a Shephard grommet was inserted anteroinferiorly through a radial incision . A careful adenoidectomy was performed , along with whatever other surgery was required in the upper respiratory tract . Pure tone audiometry was repeated forty-eight hours postoperatively and prior to discharge from hospital . Thereafter , follow up was carried out at three-monthly intervals for the first year and then review ed five years later . On each visit otoscopy and pure tone audiometry were performed and at the five-year review impedance measurement was also carried out The  treatment of deafness secondary to glue ear by grommet insertion  is compared to 150 children aged between 2 and 9 years ( mean 5.25 years ) with chronic bilateral otitis media with effusion were r and omly allocated to three groups who , in addition to unilateral myringotomy and grommet insertion  , would have an adenotonsillectomy , an adenoidectomy , or neither . The contralateral ear was assessed . Otoscopic , impedance , and audiometric findings were recorded preoperatively and at six and twelve months postoperatively . Subtraction of the no-surgery results indicates that at twelve months adenoidectomy produces otoscopic resolution of OME in 41.7 % and no-peak/peak conversion of impedance in 29.8 % . The hearing gain from adenoidectomy alone was similar to that result ing from insertion of a grommet alone , but the children having adenoidectomy required fewer reinsertions to maintain adequate subjective hearing thresholds in the treated ear ( 26 % versus 54 % ) . Tonsillectomy conferred no additional benefit . Without treatment there was a small but significant improvement in all indices at twelve months but not at six months postoperatively Objectives : To evaluate the effect of a risk factor checklist and training video for general practitioners  in reducing inter- practice variation and improving the appropriateness of referrals ( assessed by their positive predictive value or PPV ) of patients with suspected otitis media with effusion ( OME or ' glue ear ' ) to secondary care . Methods : Fifty general practice s ( 177 practitioners ) from the NHS Trent region and the West of Scotl and were cluster-r and omised either to a control group ( n = 12 ) or to one of three intervention groups ( training video ( n = 16 ) , checklist ( n = 11 ) , or both ( n = 11 ) ) . Data on all  paediatric ear , nose and throat ( ENT ) referrals and diagnostic results at ENT clinics were collected for a one-year period pre- and post-intervention . Referral rates for OME and for closely related conditions were calculated for children aged 0 - 15 years , based on each practice 's list size . PPV was defined as the proportion of referrals result ing in bilateral hearing loss ≥ 20 dB at the ENT outpatient department . Results : There was a significant improvement in the PPV , adjusted for patients ' waiting time between general practitioner ( GP ) referral and being seen at the ENT department . The improvement in PPV pre- and postintervention was 15 % ( 95 % confidence interval , CI : -12.1 % to 41.7 % ) for the practice s receiving both interventions , compared with a degradation of 20 % pre- and post-intervention ( 95 % CI : -32.9 % to -6.4 % ) for practice s receiving only one intervention and a degradation of 34 % for those receiving no intervention . Conclusions : Disseminating a risk factor checklist and training video on glue ear to GPs using a multi-channel approach can improve the quality of referrals to ENT One hundred children with glue ear , in whom surgical treatment was indicated , were r and omly allocated to 1 of 4 treatment groups . Children in 2 of the groups underwent adenoidectomy plus various combinations of ear operations while in the other 2 groups surgery was confined to the ears . The effect of adenoidectomy was assessed 6 weeks , 6 months and 1 year after surgery by means of audiometry , impedance tympanometry and parental opinion . Improvements in hearing were greater in those children who underwent an adenoidectomy than in those who did not ( 4.0 dB at 6 weeks ; 2.4 dB at 6 months ; 0.7 dB at 1 year ) . However , these differences are of little clinical significance and were only statistically significant ( P less than 0.05 ) 6 weeks after surgery . Middle ear function , measured by tympanometry , revealed a similar pattern of response to treatment . Despite this , 6 months after surgery a higher proportion of parents were satisfied with their child 's condition if an adenoidectomy had been performed . Possible explanations of this discrepancy between clinical and parental assessment s of outcome are discussed TARGET ( Trial of Alternative Regimens in Glue Ear Treatment ) is a multicentre UK r and omized controlled trial ( RCT ) comparing bilateral ventilation tubes with and without adjuvant adenoidectomy against non-surgical management in children with bilateral , persistent otitis media with effusion ( OME ) . This paper compares the recruited and r and omized children with those that , although eligible , were not included in the RCT for various reasons . This is necessary to identify any potential bias in the overall estimate of treatment effectiveness . At the first visit , 1315 children with OME satisfied the criteria of age ( 3 years 3 months-6 years 9 months ) , no previous ear or adenoid surgery , tympanometric evidence of fluid ( bilateral B or B + C2 ) and a hearing loss ( conductive loss in both ears of > or = 20 dBHL ) . Of these children , 151 ( 11 % ) were not followed up because of overriding concern and 70 ( 5 % ) because of parental refusal . Of the 506 children eligible for r and omization , because of persistence over 12 weeks of watchful waiting of bilateral OME with the same criteria , 20 ( 4 % ) were not r and omized because of overriding concern and 75 ( 15 % ) because of parental refusal . The distribution of the potential effect modifiers was determined for each group . At the first visit , the only significant differences ( P < 0.05 ) , comparing those not recruited because of overriding concern with those recruited , were in respect of sex ( 61 % girls compared with 52 % boys ) and hearing level ( 34.6 compared with 33.0 dBHL ) . At the second visit , the only significant difference involved less frequent upper respiratory tract infections ( URTIs ) in children whose parents refused to allow r and omization ( 8 % compared with 18 % had had episodic URTI more often than once every 3 months ) . It is probable that the findings from the TARGET trial will translate to the entire clinic population in this age group as long as they meet the same audiometric and tympanometric criteria . The differences found can be h and led by presentation of disaggregated results OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of topical mometasone in children with bilateral otitis media with effusion ( OME ) . DESIGN A double-blind r and omised placebo-controlled trial with an intention to treat analysis ; the 10.6 % of patients lost to follow-up at 1 month were censored in the analysis . SETTING 76 Medical Research Council General Practice Research Framework practice s throughout the UK between 2004 and 2007 . PARTICIPANTS A sample of 217 children aged 4 - 11 years was selected from those presenting to their GP with one or more episodes of otitis media or ear-related problems in the previous 12 months whom the research nurse confirmed had bilateral glue ear using microtympanometry ( B B or B C2 types using a modified Jerger classification ) at r and omisation . INTERVENTIONS Mometasone 50 micrograms in each nostril or placebo spray once daily for 3 months . MAIN OUTCOME MEASURES The primary outcome was the proportions of children cleared of OME assessed by tympanometry at 1 month . Secondary outcomes included clearance at 3 months and 9 months ; adverse events ; OM8 - 30 scores ( a functional health status responsive disease-specific measure ) ; hearing loss ; days with otalgia ; cost-effectiveness ; and health utilities . RESULTS Of the topical steroid group , 40.6 % ( 39/96 ) demonstrated tympanometric clearance ( C1 or A type ) in one or both ears at 1 month , compared with 44.9 % ( 44/98 ) of the placebo group . The absolute risk reduction at 1 month was -4.3 % ( 95 % CI -18.05 % to 9.26 % ) ; the odds ratio ( OR ) was 0.84 ( 95 % CI 0.48 to 1.48 ) . Four covariates were pre-specified for inclusion in logistic regression analysis : age as a continuous variable ( p = 0.94 ) , season ( p = 0.70 ) , atopy ( p = 0.61 ) and clinical severity ( p = 0.006 ) . The adjusted OR ( AOR ) at 1 month for the main outcome was 0.93 ( 95 % CI 0.50 to 1.75 ) . Secondary analysis at 3 months showed 58.1 % of the steroid group had resolved and 52.3 % of the placebo group , AOR 1.45 ( 95 % CI 0.74 to 2.84 ) . At 9 months 55.6 % of the treated group remained clear in at least one ear and 65.3 % of the placebo group , AOR 0.82 ( 95 % CI 0.39 to 1.75 ) . Adverse events ( although relatively minor ) occurred in 7 - 22 % of children and included nasal stinging , epistaxis , dry throat and cough . The OM8 - 30 scores ( p = 0.55 ) reported hearing difficulty ( p = 0.08 ) , and days with otalgia ( p = 0.46 ) were not significantly different between groups at 3 months . The economic evaluation found the active treatment arm to be dominated by placebo , accruing slightly ( but not significantly ) higher costs and fewer quality -adjusted life-years ( QALYs ) , with a 24.2 % probability that topical steroids are a cost-effective use of NHS re sources at a ceiling ratio of 20,000 pounds per QALY gained . CONCLUSIONS Use of topical intranasal corticosteroids is very unlikely to be a clinical ly effective treatment for OME ( glue ear ) in the primary care setting . TRIAL REGISTRATION Current Controlled Trials IS RCT N38988331 OBJECTIVE To pilot a model for determining whether homoeopathic treatment of children suffering from glue ear is more effective than st and ard GP care at producing a return to normal hearing ( a hearing loss of less than 20 dB ) within 12 months . DESIGN Non-blind , r and omized controlled trial . SETTING General practice in two locations in southern Engl and . SUBJECTS Thirty-three children aged 18 months to 8 years with otitis media with effusion , hearing loss > 20 dB and an abnormal tympanogram . OUTCOME MEASURES Hearing loss , tympanogram , referrals to specialists and number of courses of antibiotics at 12 month follow-up . RESULTS A higher proportion of children receiving homoeopathic care had a hearing loss less then 20 dB at follow-up ( 64 vs 56 % ) , though this difference did not reach statistical significance ( 95 % confidence interval for the difference between means of -25 and 42 % ) . More homoeopathy patients than controls had a normal tympanogram ( 75 vs 31 % , P = 0.015 ) . Referrals to specialists and antibiotic consumption was lower in the homoeopathy group , though differences between groups did not reach statistical significance . CONCLUSION Further research comparing homoeopathy to st and ard care is warranted . Assuming recovery rates of 50 and 30 % in homoeopathy and st and ard care groups respectively , 270 patients would be needed for a definitive trial Fifty-four children with established chronic secretory otitis media , who had failed to respond to medical measures were treated with adenoidectomy and insertion of 1 grommet on a side chosen at r and om . Both sides improved and remained significantly improved at 12 months ( P less than 0.001 ) . At 3 months , the side with the grommet improved significantly more than the other side ( P less than 0.05 ) but at 12 months there was no significant difference between the 2 sides ( P greater than 0.1 ) The object of this study was to compare the effect on the hearing of the insertion of a grommet , with or without adenoidectomy , against a non-surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion . Seventy-eight children ( 44 boys , 34 girls , mean age 5.8 years ) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment ( pure tone average air conduction thresholds over 0.5 , 1 and 2 kHz of > or = 25 dB HL ) over a three month period were admitted to a r and omized , controlled trial . Each child was r and omized to have or not to have an adenoidectomy . The ears in each child were then r and omly allocated to have a grommet ( tympanostomy tube ) inserted . The children 's hearing status was review ed six and 12 months post-operatively . During follow-up , should a child redevelop a persistent bilateral hearing impairment ( as defined above ) for three months they were managed with a hearing aid . Thus no child had repeat insertion of a grommet . Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post-operatively but not at 12 months when it was no different from natural resolution . If resolution of the otitis media with effusion is the outcome measure , then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls . Even in boys it only resolves about 60 per cent of effusions . However , when combined with a grommet ( one insertion ) adenoidectomy gives no greater resolution ( 89 per cent compared with 86 per cent ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE Otitis media is 1 of the most frequent diseases of early infancy and childhood and 1 of the most common reasons for children to visit a physician . In the past 2 decades , there has been a substantial increase in the diagnosis of otitis media worldwide . In the United States , 93 % of all children have had at least 1 episode of acute otitis media ( AOM ) by 7 years of age . Otalgia is the hallmark of AOM . Most affected children either complain of earache or manifest behavior that the parents interpret as indicating ear pain . Treatment of the ear pain early in the course of AOM decreases both parental anxiety and the child 's discomfort and accelerates the healing process . The objective of this study was to determine the efficacy and tolerability of naturopathic versus traditional treatment for the management of otalgia commonly associated with AOM in children . METHODS The study was design ed as a double-blind trial in an outpatient community clinic . A total of 171 children who were aged 5 to 18 years and had otalgia and clinical findings associated with middle-ear infection were studied . The children were r and omly assigned to receive treatment with Naturopathic Herbal Extract Ear Drops ( NHED ) or anesthetic ear drops , with or without amoxicillin . On enrollment , the children were assigned by computer-numbered r and omization to receive NHED ( contents : allium sativum , verbascum thapsus , calendula flores , hypericum perfoliatum , lavender , and vitamin E in olive oil ) 5 drops 3 times daily , alone ( group A ) or together with a topical anesthetic ( amethocaine and phenazone in glycerin ) 5 drops 3 times daily ( group B ) , or oral amoxicillin 80 mg/kg/d ( maximum 500 mg/dose ) divided into 3 doses with either NHED 5 drops 3 times daily ( group C ) or topical anesthetic 5 drops 3 times daily ( group D ) . A double-blind design was used , and all ear drops were placed in identical bottles . Treatment was initiated by the nurse in all cases . A single physician ( M.S. ) evaluated and treated all of the patients included in the study and recorded all of the data . The presence or absence of ear pain was assessed over 3 days with a visual analog scale . Ear pain was assessed by a specially devised observational instrument based on previous reports . One side of the instrument consisted of a linear numbered scale , from 1 ( no pain ) to 10 ( worst possible pain ) , and a corresponding color scale , ranging from blue to dark red . The reverse side contained a scale of 5 facial expressions , ranging from broad smile ( no pain ) to a sad and crying face ( worst possible pain ) , and a corresponding color scale , ranging from blue to dark red . RESULTS There were no significant between-group differences in patient age or gender , degree of fever , main symptoms , associated symptoms , and severity or laterality of acute otitis media . Each group had a statistically significant improvement in ear pain over the course of the 3 days . Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin . Results were better in the NHED group than in the controls . Nevertheless , the findings indicated that the pain was mostly ( 80 % ) self-limited and could be explained simply by the time elapsed . The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend topical medications as the first line of treatment for ear pain in the absence of systemic infection or serious underlying disease . Because no evidence was found that systemic antibiotics alone improved treatment outcome , if antibiotics do not change the natural course of otitis media , then the main goal of treatment , as in the present study , should be to alleviate the ear pain . The alternative , naturopathic herbal extract medications , may offer many new possibilities in the management of ear pain associated with AOM . Primary care physicians should be aware that at least 10 % of their patients may have tried 1 or more forms of alternative/complementary medicine before presenting for consultation . As it was widely reported in the medical literature , these herb , these herbal extracts have the potential to meet all of the requirements of appropriate medication that could be routinely used in the pediatric patient , namely in vitro bacteriostatic and bacteriocidal activity against common pathogens , immunostimulation ability , antioxidant activity , and anti-inflammatory effects . They are also well-absorbed with good penetration into the tissue surrounding the tympanic membrane . They have been found to enhance local immunologic activity . Finally , herbal extracts are well-tolerated ( owing to their long elimination time ) , easy to administer , and less expensive than the new antibiotics . There are no documented side effects . On the basis of our findings that the group with the most significant treatment effects ( NHED with topical anesthetic ) explained only 7.3 % of the total pain reduction , we propose that sometimes the general practitioner or pediatrician needs to give the human body a chance to repair itself . Nevertheless , if the physician believes that there is an indication for some treatment , especially if the parents are anxious , then a local treatment such as one used in our study might be adequate . CONCLUSIONS This study suggests that in cases of ear pain caused by AOM in children in which active treatment , besides a simple 2- to 3-day waiting period , is needed , an herbal extract solution may be beneficial . Concomitant antibiotic treatment is apparently not contributory OBJECTIVE To assess the effectiveness of a homeopathic ear drop for treatment of  otalgia in children with acute otitis media ( AOM ) . METHODS Children with AOM were enrolled in the study at the time of diagnosis and r and omized to receive either st and ard therapy alone or st and ard therapy plus a homeopathic ear drop solution that was to be used on as needed basis for up to 5 days . Parents of children in both treatment groups rated the severity of 5 AOM symptoms twice daily for 5 days in a symptom diary . A symptom score was computed for each assessment with lower scores denoting less severe symptoms . Parents of children r and omized to receive ear drops also recorded information regarding symptoms being treated and response to treatment . RESULTS A total of 119 eligible children were enrolled in the study ; symptom diaries were received from 94 ( 79 % ) . Symptom scores tended to be lower in the group of children receiving ear drops than in those receiving st and ard therapy alone ; these differences were significant at the second and third assessment s ( P = 0.04 and P = 0.003 , respectively ) . In addition , the rate of symptom improvement was faster in children in the ear drop group compared with children in st and ard therapy alone group ( P = 0.002 ) . The most common reason for administration of ear drops was ear pain , recorded for 93 doses ; improvement was noted after 78.4 % of doses for this indication . There were no significant side effects related to use of the ear drops . CONCLUSIONS This study suggests that homeopathic ear drops were moderately effective in treating otalgia in children with AOM and may be most effective in the early period after a diagnosis of AOM . Pediatricians and other primary health care providers should consider homeopathic ear drops a useful adjunct to st and ard therapy This trial was design ed to compare early surgery with watchful waiting for persistent bilateral otitis media with effusion ( OME ) in terms of hearing loss and behavioural problems in pre-school children . A r and omised controlled trial compared the effects of early treatment with ventilation tubes versus watchful waiting for 9 months . Results were analysed by intention-to-treat . One hundred and eighty-two pre-school children ( date of birth between 1 April 1991 and 31 December 1992 ) , mean age of 2.9 years ( SD 0.85 ) with at least a 3-month history of bilateral OME and hearing loss of greater than 25 dB were treated in Bristol Children 's Hospital between November 1993 and January 1996 .  Bilateral ventilation tubes were inserted within 6 weeks of r and omisation or within 6 weeks of re assessment after 9 months of watchful waiting , with a final assessment at 18 months . The main outcome measures were behavioural problems , measured by the Richman Behaviour Checklist , and hearing loss at 4000 Hz in the better hearing ear . Early surgical intervention significantly reduced behavioural problems by 17 % ( 95 % CI , 2 % - 33 % ) . This difference was largely mediated by concurrent hearing loss . After 18 months , there was no longer a significant difference ( 95 % Cl , -19 % to + 10 % ) . However , the majority ( 85 % ) of the Watchful Waiting group had required surgery and 22 % of all children still had behavioural problems A prospect i ve study was conducted of the effects of adenoidectomy and adenotonsillectomy on established otitis media with effusion unresponsive to medical treatment . The operations were performed at r and om with a controlled no surgery group on a cohort of 103 children with the condition and the results assessed six weeks , three months , six months , nine months , and one year later . After adenoidectomy the rate of resolution of the condition increased from 39 % at six weeks to 72 % at one year ; and after adenotonsillectomy the rate increased from 59 % at six weeks to 62 % at one year . In the no surgery group the rate increased from 16 % at six weeks to 26 % at one year . Compared with the no surgery group the effect of adenoidectomy alone at one year was highly significant ( p less than 0.001 ) , and similarly the effect of  adenotonsillectomy  was significant ( p less than 0.01 ) . There was , however , no increased benefit from the addition of tonsillectomy compared with adenoidectomy alone . Thus there was resolution of 36 - 46 % of chronic effusions as a result of adenoidectomy Background : Chronic suppurative otitis media ( CSOM ) affects many children in disadvantaged population s. The most appropriate topical antibiotic treatment in children with persistent disease is unclear . Methods : Children with CSOM despite st and ard topical treatment were r and omized to 6–8 weeks of topical ciprofloxacin ( CIP ) versus topical framycetin-gramicidin-dexamethasone ( FGD ) .  Otoscopic , audiologic , and microbiologic outcomes were measured using st and ardized assessment s and blinding . Results : Ninety-seven children were r and omized . Ear discharge failed to resolve at the end of therapy in 70 % children regardless of allocation [ risk difference = −2 % ; ( 95 % CI : −20 to 16 ) ] . Healing of the tympanic membrane occurred in one of 50 children in the CIP group and none of 47 children in the FGD group . Severity of discharge failed to improve in more than 50 % children in each group , and mean hearing threshold ( 38 dB and 35 dB ) and proportion of children with greater than 25 dB hearing loss ( 98 % and 88 % ) were not significantly different between the CIP and FGD groups . Side effects were rare . Conclusions : This study showed a similarly low rate of improvement or cure in children with persistent CSOM for both CIP and FGD topical therapies . Complications and side effects were insufficient to cease therapy or inform prescribing of either therapy
ConclusionS -carboxymethylcysteine is effective in the treatment of children with glue ear .
Objective To establish the clinical relevance of S-carboxymethylcysteine in the treatment of glue ear in children using measures approximating those saving a child from operation for grommet insertion .