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Zinc supplements for preventing otitis media
Anjana Gulani1, Harshpal S Sachdev
1Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India. gulani73@yahoo.com.
Insights
Zinc supplements show mixed results for preventing otitis media (OM) in children. While some evidence suggests a benefit for malnourished infants, more research is needed for healthy children in low-income settings.
Area of Science:
- Pediatrics
- Nutritional Science
- Infectious Diseases
Background:
- Otitis media (OM), a common middle ear infection, disproportionately affects young children and causes significant long-term hearing loss, particularly in low-income countries.
- Given the established role of zinc in preventing pneumonia in disadvantaged children, its potential to prevent OM warrants investigation.
Purpose of the Study:
- To systematically evaluate the efficacy of zinc supplementation in preventing otitis media (OM) across diverse age groups, including adults and children.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE) up to February 2012.
- Included studies were randomized, placebo-controlled trials administering zinc supplements at least weekly for a minimum of one month.
- Data extraction and analysis were performed independently by two reviewers, with results summarized using risk ratios and mean differences.
Main Results:
- Twelve trials involving 6820 participants were identified; 10 contributed outcome data.
- In healthy children from low-income communities, two trials found no significant difference in OM incidence between zinc and placebo groups.
- One trial indicated a reduced OM incidence rate with zinc supplementation (RR 0.69), and a small trial suggested a benefit for malnourished infants (MD -1.12 episodes).
Conclusions:
- The evidence regarding zinc supplementation's effectiveness in preventing OM in healthy children under five in low- and middle-income countries is inconclusive.
- A potential benefit was observed in infants with severe malnutrition (marasmus), but this finding requires cautious interpretation due to the limited evidence from a single small trial.
Background:
Otitis media (OM) is inflammation of the middle ear and is usually caused by infection. It affects people of all ages but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries. As zinc supplements prevent pneumonia in disadvantaged children, we wanted to investigate whether zinc supplements could also prevent OM.
Objectives:
To evaluate whether zinc supplements prevent OM in adults and children of different ages.
Search Methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 1) which includes the Cochrane Acute Respiratory Infections Groups' Specialised Register, MEDLINE (1950 to February week 1, 2012) and EMBASE (1974 to February 2012).
Selection Criteria:
Randomised, placebo-controlled trials of zinc supplements given at least once a week for at least a month for preventing OM.
Data Collection And Analysis:
Two review authors independently assessed the eligibility and methodological quality of the included trials and extracted and analysed data. We summarised results using risk ratios (RRs) or rate ratios for dichotomous data and mean differences (MDs) for continuous data. We combined trial results where appropriate.
Main Results:
We identified 12 trials for inclusion, 10 of which contributed outcomes data. There was a total of 6820 participants. In trials of healthy children living in low-income communities, two trials did not demonstrate a significant difference between the zinc supplemented and placebo groups in the numbers of participants experiencing an episode of definite OM during follow-up (3191 participants); another trial showed a significantly lower incidence rate of OM in the zinc group (rate ratio 0.69, 95% confidence interval (CI) 0.61 to 0.79, n = 1621). A small trial of 39 infants undergoing treatment for severe malnutrition suggested a benefit of zinc for the mean number of episodes of OM (mean difference (MD) -1.12 episodes, 95% CI -2.21 to -0.03). Zinc supplements did not seem to cause any serious adverse events but a small minority of children were reported to have vomited shortly after ingestion of the supplements. The trial evidence included is generally of good quality, with a low risk of bias.
Authors' Conclusions:
Evidence on whether zinc supplementation can reduce the incidence of OM in healthy children under the age of five years living in low- and middle-income countries is mixed. There is some evidence of benefit in children being treated for marasmus (severe malnutrition) but this is based on one small trial and should therefore be treated with caution.
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