局部和口服类固醇用于儿童中耳炎与输液 (OME) 的治疗
Caroline A Mulvaney1, Kevin Galbraith1, Katie E Webster1
1Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
The Cochrane database of systematic reviews
|December 13, 2023
概括
这次审查发现,口服类固醇可能为患有中耳炎与溢出 (OME) 的儿童提供最小的益处,听力或生活质量几乎没有改善. 鼻腔类固醇也有不确定的效果,对其影响和潜在的副作用的证据有限.
科学领域:
- 儿科耳鼻喉科 儿科耳鼻喉科
- 对于耳部疾病的药理干预措施
- 儿童健康的基于证据的医学.
背景情况:
- 中耳炎与溢出 (OME) 是幼儿常见的病症,其特征是中耳液积聚.
- 持续的OME可能导致听力损失,行为问题和语言发育延迟.
- 目前的管理策略包括警等待,医疗和手术干预,有时使用类固醇治疗炎症.
研究的目的:
- 评估局部和口服类固醇治疗儿童群体OME的疗效和安全性.
- 与安慰剂或没有治疗相比,评估类固醇干预措施的益处和危害.
主要方法:
- 随机对照试验 (RCT) 和准RCT的系统审查和元分析,涉及患有OME的6个月至12岁儿童.
- 研究比较了口服或局部类固醇与安慰剂或警等待.
- 主要结局包括听力状况,OME特异性生活质量和系统性皮质类固醇副作用,使用GRADE标准进行评估.
主要成果:
- 与安慰剂相比,口服类固醇在听力或生活质量方面几乎没有显著差异,尽管它们可能会略微减少OME持久性.
- 局部 (鼻腔) 类固醇显示非常低至低确定性证据,对听力,生活质量和OME持久性影响不清楚.
- 关于口服和鼻腔类固醇系统和局部副作用风险的证据有限且不确定.
结论:
- 口服类固醇似乎对儿童的OME提供了最小的临床益处,在减少持久性疾病方面可能有很小的优势,需要仔细考虑风险和益处.
- 由于低确定性证据和对不良影响的数据有限,鼻类固醇对OME结果的影响仍然不清楚.
- 鉴于大多数OME病例会自发消失,未来的研究应该集中于确定最有可能从干预中受益的儿童,而不是普遍治疗.
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