Otitis media with effusion (OME) or 'glue ear' is very common in children and the hearing loss and discomfort, especially where the effusion is bilateral and long-lasting, may lead to problems with language, development and behaviour. There are a number of treatment options including steroids, antibiotics, decongestants, antihistamines and surgery (the insertion of grommets (ventilation tubes)). Grommet insertion is one of the commonest operations of childhood. The best treatment strategy remains controversial, however, as glue ear often resolves spontaneously within a few months.
Autoinflation is a technique whereby the Eustachian tube (the tube that connects the middle ear and the back of the nose) is reopened by raising pressure in the nose. This can be achieved by forced exhalation with closed mouth and nose, blowing up a balloon through each nostril or using an anaesthetic mask. The aim is to introduce air into the middle ear, via the Eustachian tube, equalising the pressures and allowing better drainage of the fluid.
This review included six randomised controlled trials of autoinflation for glue ear. All of the studies were small, of limited treatment duration and short follow up.
The review authors used a combined outcome measure which included any outcome signifying improvement (as defined in individual studies) and measured outcomes at the time points 'up to one month' and 'greater than one month'. Improvement was demonstrated in both the 'up to one month' and 'greater than one month' analyses. Subgroup analysis based on the type of intervention showed a significant effect using a Politzer device at both under one month and over one month. None of the studies demonstrated a significant difference in the incidence of side effects between interventions.
The authors conclude that evidence for the use of autoinflation in the short term is favourable. However, given the small number of studies and the lack of long-term follow up, the long-term effects associated with the use of these devices cannot be determined.