Review article A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media Jørgen Lous *, Christina T. Ryborg, Janus L. Thomsen Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Denmark Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1058 1.1. Aim of this review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1059 2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1059 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1059 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1061 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1061 1. Introduction Acute otitis media (AOM) is common in preschool children and recurrent acute otitis media (RAOM) can be a great strain on both the child and the family. RAOM is three or more episodes with AOM in six months or four episodes in one year with periods with no symptoms in between. Between 10 and 20% of children experience RAOM during childhood. During the last decades it has become more common to use tympanostomy tubes as a treatment in cases with RAOM as an alternative to long-term or recurrent treatment with antibiotics [1–3]. What is the scientific evidence for treatment with tympanost- omy tubes in children with RAOM? A recently published Cochrane review by McDonald et al. tried to answer the question by analyzing randomized studies on this topic [4]. They searched in MEDLINE, EMBASE, CINAHL and other databases for randomized trials on children up to 16 years of age with RAOM. They found five studies, all with different treatment in the control groups [5–9]. They ended up including only two of the International Journal of Pediatric Otorhinolaryngology 75 (2011) 1058–1061 A R T I C L E I N F O Article history: Received 14 March 2011 Received in revised form 5 May 2011 Accepted 7 May 2011 Available online 2 June 2011 Keywords: Recurrent acute otitis media Preschool children Tympanostomy tubes (grommets) Systematic review Randomized controlled trials A B S T R A C T Objective: Documentation of the effect of tympanostomy tubes in children with recurrent acute otitis media (RAOM) is limited. A recently published Cochrane review on the effect of tympanostomy tubes in children with RAOM was based on only two studies. Could the documentation be increased by including other randomized studies? Methods: A MEDLINE and EMBASE search for randomized controlled trials was performed and 143 eligible papers were found. Only five studies could be included. All five were randomized studies with a total of 519 children, four randomized by children and one by ears. All five studies had different designs and control groups, making a proper meta-analysis impossible. Three studies had an antibiotic treated group, two studies a placebo group, and two studies a no treatment group as comparison group. Outcome measures were rates of AOM or fraction free of AOM in six or 12 months. Results: Between two and five children have to be treated with tympanostomy tubes to prevent one child from attacks of acute otitis media (AOM) in six months. Tube treatment could reduce AOM with about one attack in six months after operation. Six months treatment with antibiotics was not different from treatment with tubes. No study reported quality of life for child and family or parental absence from day care or work. Conclusion: Insertion of tympanostomy tubes or long-term treatment with antibiotics seems to prevent one attack of AOM or keep one child out of three free from AOM in six months. ß 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Research Unit of General Practice, University of Southern Denmark, J B Winsløw Vej 9A, 5000 Odense C., Denmark. Tel.: +45 8627 3471. E-mail address: jlous@health.sdu.dk (J. Lous). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l 0165-5876/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2011.05.009