What are some systematic review ideas in pediatric otorhinolaryngology (pediatric ear, nose, and throat medicine)?

Systematic Review Ideas in Pediatric Otorhinolaryngology

High-Priority Topics with Evidence Gaps

Comparative Effectiveness of Surgical Interventions

Adenoidectomy timing and technique optimization for recurrent otitis media

• Current guidelines show adenoidectomy reduces OME and improves hearing when combined with tympanostomy tubes or myringotomy, but optimal timing remains unclear 1
• Evidence gaps exist regarding which children aged 2-4 years benefit most from adenoidectomy as an adjunct to tubes versus tubes alone 1
• Comparative studies of adenoidectomy techniques (curettage vs. powered instrumentation) on outcomes including hemorrhage rates and efficacy are lacking 2

Long-term developmental outcomes following tympanostomy tube placement

• Existing systematic reviews show tubes improve hearing for 6 months but find no evidence of beneficial effects on language development 1
• The 2022 guideline update acknowledges that tubes and watchful waiting do not differ in language, cognitive, or academic outcomes, but long-term studies beyond 2 years are absent 2
• A systematic review examining developmental outcomes at school age (5-12 years) in children who received tubes versus watchful waiting for chronic OME would address this critical gap 1

Treatment Efficacy and Safety

Optimal duration and type of tympanostomy tubes for different clinical scenarios

• Guidelines mention short-term, intermediate, and long-term tube options but provide insufficient evidence on which tube duration is superior for specific indications 1
• Comparative effectiveness of tube types (composition, design) on outcomes including otorrhea rates, extrusion timing, and need for repeat surgery requires systematic evaluation 1

Medical management alternatives to surgery

• Auto-inflation devices show small positive effects in meta-analysis, but the 2017 guideline notes only one small crossover study since the 2013 Cochrane review 1
• Systematic review of vitamin D supplementation, probiotics/prebiotics, and xylitol for preventing recurrent AOM would consolidate emerging evidence 1
• Nasal steroid efficacy for OME in children with adenoid hypertrophy needs comprehensive systematic review beyond single trials 1

Surgical Decision-Making and Patient Selection

Risk stratification tools for identifying children who benefit most from tubes

• Current guidelines list risk factors for developmental difficulties but lack validated prediction models 1
• A systematic review developing and validating clinical decision rules for tube candidacy in children with chronic OME would reduce practice variation 1
• Comparative outcomes in children with versus without baseline middle ear effusion at time of tube placement for recurrent AOM requires synthesis 1

Optimal surveillance intervals and hearing assessment protocols

• Guidelines recommend 3-6 month surveillance intervals but evidence supporting this specific timeframe is observational 1
• Systematic review of hearing assessment frequency and methods (audiometry vs. tympanometry) for detecting clinically significant changes in children with chronic OME 1

Complications and Quality of Life

Prevention and management of tube-related otorrhea

• Tube-related otorrhea occurs in 16% within 4 weeks and 26% at any time, with 7% experiencing recurrent episodes, but optimal prevention strategies are unclear 1
• Systematic review comparing perioperative topical antibiotic preparations, water precautions, and post-operative care protocols on otorrhea rates 1

Quality of life outcomes across different management strategies

• Tube insertion shows short-term QOL improvements at 18 months, but comparative long-term QOL data across surgical and non-surgical approaches are limited 1
• Systematic review examining caregiver burden, child emotional distress, and activity limitations across watchful waiting, medical management, and surgical interventions 1

Emerging and Underexplored Areas

Balloon dilation of the eustachian tube in pediatric populations

• The 2017 guideline identified only uncontrolled adult case series with heterogeneous methods and no long-term follow-up 1
• Systematic review of safety, efficacy, and patient selection criteria for balloon dilation in children would establish evidence base for this emerging technique 1

Intratympanic steroid injections for persistent OME

• One trial in adults and older children showed benefit on subjective symptoms and middle ear effusion, but pediatric-specific evidence is lacking 1
• Systematic review of intratympanic steroid safety, efficacy, and optimal protocols in children aged 2-12 years 1

Outcomes in special populations

• Children with Down syndrome, cleft palate, autism spectrum disorder, and other conditions predisposing to chronic OME are excluded from most RCTs 1
• Systematic reviews examining surgical outcomes, complication rates, and developmental trajectories in these high-risk populations would inform individualized care 1

Perioperative Management

Anesthesia-related outcomes and alternatives

• Anesthesia-related death ranges from 1 in 10,000 to 1 in 45,000, with children more prone to laryngospasm and bronchospasm than adults 1
• Systematic review of anesthetic techniques, emergence delirium prevention, and alternatives to general anesthesia for tube placement 1

Pain management protocols

• Guidelines recommend pain management but specific protocols and comparative effectiveness of different analgesic regimens are not systematically reviewed 1
• Systematic review of perioperative pain management strategies including timing, dosing, and multimodal approaches 1

Health Services and Implementation Research

Practice variation and guideline adherence

• Canadian survey showed 40% of otolaryngologists would "never" place tubes for recurrent AOM without persistent MEE, while 30% would "often or always" 1
• Systematic review of factors influencing surgical decision-making, guideline implementation barriers, and strategies to reduce unwarranted practice variation 1

Cost-effectiveness analyses

• Comparative cost-effectiveness of watchful waiting, medical management, and surgical interventions across different healthcare systems requires systematic synthesis 1