Are steroids effective for treating otitis media with effusion (fluid in the ears)?

From the Guidelines

Steroids should not be used to treat ear infections with fluid buildup, as medical treatment does not work well and there are no benefits to using steroids, antihistamines, decongestants, or drugs to reduce acid reflux. According to the clinical practice guideline: otitis media with effusion executive summary (update) 1, the use of steroids, either by mouth or in the nose, does not help the fluid go away. The guideline recommends watchful waiting for the first 3 months, as fluid often goes away on its own, and advises against the use of medical treatments, including steroids.

The benefits of avoiding interventions in an often self-limited condition, such as ear fluid, outweigh the potential harms of treatment. The guideline emphasizes the importance of avoiding unnecessary interventions and recommends a strong recommendation against the use of steroids and other medical treatments.

Some key points to consider when managing ear fluid include:

• Keeping the child away from secondhand smoke
• Stopping the use of pacifiers in children over 12 months old
• Following up with the doctor every 3 to 6 months until the fluid goes away
• Being patient and understanding with the child, as hearing difficulties can be frustrating
• Speaking clearly and face-to-face with the child to help them hear better.

It is essential to prioritize the child's hearing and overall well-being, and to follow the guideline's recommendations to avoid unnecessary interventions and potential harms.

From the Research

Steroids for Ear Infection due to Fluid in Ears

• The use of steroids for treating otitis media with effusion (OME) has been studied in several trials 2, 3, 4, 5, 6.
• A 2023 systematic review found that oral steroids may have little effect in the treatment of OME, with little improvement in the number of children with normal hearing and no effect on quality of life 2.
• The same review found that topical (nasal) steroids had low- or very low-certainty evidence, making it unclear if they have any impact on hearing, quality of life, or persistence of OME 2.
• A 1990 study found that a course of prednisone for 7 days plus trimethoprim-sulfamethoxazole for 30 days resulted in complete resolution of middle ear effusion in 71% of patients 3.
• A 2011 systematic review found that oral steroids, especially when used in combination with an oral antibiotic, lead to a quicker resolution of OME in the short term, but there is no evidence of longer-term benefit and no evidence that they relieve symptoms of hearing loss 4.
• The 2016 clinical practice guideline for otitis media with effusion recommends against using intranasal or systemic steroids for treating OME, as well as systemic antibiotics, antihistamines, and decongestants 5.
• A 2001 systematic review found that steroids alone or combined with an antibiotic lead to a quicker resolution of OME in the short-term, but there is no evidence for a long-term benefit from treating hearing loss associated with OME with either oral or topical nasal steroids 6.

Key Findings

• Oral steroids may have little effect in the treatment of OME 2.
• Topical (nasal) steroids have low- or very low-certainty evidence, making it unclear if they have any impact on hearing, quality of life, or persistence of OME 2.
• Steroids may lead to a quicker resolution of OME in the short-term, but there is no evidence of longer-term benefit 3, 4, 6.
• The use of steroids for treating OME is not recommended due to lack of evidence for long-term benefit and potential side effects 5, 6.