Despite being so common, there are still many questions and controversies concerning the best way to treat children suffering from ear infections. One question that persists is the role of steroids in the treatment of ear infections.
It's important to understand that not all ear infections are the same. Ear infections can be acute, meaning they start suddenly and are usually quite painful; chronic meaning they last for one month or longer but are usually not very painful; and with effusion meaning there is fluid behind the ear drum.
A recent study evaluated the role of steroids in the treatment of chronic middle ear effusion. Many doctors treat this problem with steroids in the belief they reduce inflammation, promote the drainage of the fluid, and prevent any recurrence of the problem.
Doctors from the Children's Hospital of Pittsburgh enrolled 144 children, ages one to nine year old. in this study. All had middle ear effusion for at least two months. Four different treatments were used: steroid plus amoxicillin for 14 days followed by amoxicillin alone for another 14 days; steroid and amoxicillin for 14 days followed by placebo (substituting for amox-icillin) for another 14 days; placebo (for the steroid) and amoxicillin for 14 days followed by amoxicillin for another 14 days; and placebo (for steroid) and amoxicillin for 14 days followed by placebo (for amoxicillin) for another 14 days.
The children were evaluated after two and four weeks of treatment. The doctors who evaluated the children didn't know which medicines the children were receiving. Over 90% of the children completed the study.
A number of tests were performed on the children. Otoscopy (looking at the ear and ear drum), tymÂpanÂometry (measuring the mobility of the ear drum), and audiometry (measuring hearing ability) were performed when the children entered the study and at the two and four week check ups.
After two weeks of treatment, more of the children who received the steroids and amoxicillin had no middle effusion than those who receive the amoxicillin alone. However, at the four week check up, this difference disappeared.
The researchers conclude that, "...treatment with the dose and type of steroid used in this study should be universally recommended for treatment of chronic otitis media with effusion, and treatment with amoxicillin, if used, should not continue beyond 14 days.
Pediatrics, 12/02, pp. 19071-1080.
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