Oral dexamethasone for treatment of persistent middle ear effusion

A double-blind controlled study of oral dexamethasone (in a 2-week tapering dose from .15 mg/kg/d) v placebo in 49 pediatric patients (mean age 3.7 years) with persistent asymptomatic middle ear effusion of three or more weeks duration was conducted. Middle ear effusion resolution was determined by a myringotomy-validated algorithm that combined pneumatic otoscopy and tympanometry. Four weeks after completing treatment, 1/26 (4%) patients receiving dexamethasone and 2/23 (9%) patients receiving placebo had completely cleared their middle ear effusion (95% confidence interval -0.05 +/- 0.14). Five of 26 (19%) patients receiving dexamethasone and 6/23 (26%) patients receiving placebo had improved their hearing in all affected ears by 10 dB or more (95% confidence interval -0.07 +/- 0.23). Oral dexamethasone as used in this study was not effective in treating persistent middle ear effusion in children.