What not to do for OME

Children with otitis media with effusion (OME) are frequent visitors to the pediatric office, as their parents seek your help in coping with this often chronic condition. A new review of multiple studies provides data to back up your advice about treating the condition with decongestants and antihistamines: Don't do it. These drugs, the studies conclude, are no better than placebo in alleviating symptoms or avoiding complications of OME. And they carry a significant risk of adverse side effects.

The review finds no benefit from these therapies for any of the short- or long-term outcomes of OME, including resolution of the fluid, hearing problems, or the need for specialist referral. What's worse, however, is the finding that these remedies are often linked to "non-trivial" adverse side effects including insomnia, hyperactivity, drowsiness, behavioral changes, and variability in blood pressure that can impair a child's functioning at home and at school. In short, says Richard Rosenfeld, MD, director of pediatric otolaryngology at Long Island College Hospital in Brooklyn, NY, and co-chair of the AAP guidelines on the treatment of OME, "If you're going to subject a child to any medication that has a potential for harm, there needs to be some assurance of benefit." On the evidence, that's not the case here. As Dr. Rosenfeld says, "You're better off doing nothing."

You can read the study online: Griffin GH et al: Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database of Syst Rev 2006;18:CD003423.