Acute otitis media is a common disease of childhood, involving inflammation of the space behind the eardrum (the middle ear cleft). Episodes typically involve a fever and a build up of pus that stretches the eardrum causing severe pain. The drum may then rupture, relieving the pain, and a discharge of pus enters the ear canal. A small proportion of children suffer with recurrent acute otitis media, which is defined as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year.
One of the strategies used to treat this condition is the insertion of a miniature plastic ventilation tube (or grommet) into the eardrum, which prevents the painful accumulation of pus in the middle ear. This review aims to assess the evidence for the effectiveness of this treatment in reducing recurrent acute otitis media.
We searched for scientific studies which compared treating children with recurrent acute otitis media with either grommets or a non-surgical treatment such as antibiotics (or no treatment). In these studies, children with grommets in place were considered to have suffered an episode of acute otitis media if they had a discharge of pus from the ear.
Two suitable studies were found to be suitable for further analysis. The combined results from these two studies suggested that more children treated with grommets are rendered symptom-free in the six months following surgery compared to those who receive other treatments or no treatment. One of the two included studies, involving 95 children, showed that grommets reduce the number of episodes of acute otitis media in the first six months after surgery, by an average of 1.5 episodes per child.
When considering the size of this effect, it is important to bear in mind that the studies were not perfect in their design and execution. To be confident in these findings further high-quality research is required.